The number of deaths globally due to smokeless tobacco has gone up by a third in seven years to an estimated 350,000 people, suggests a study from the University of York published in BMC Medicine. The research comes at a time when there are concerns that spitting – a behaviour common among those who chew tobacco – may transmit COVID-19.
The researchers – who are part of an international group called ASTRA – are calling for governments and public health bodies to regulate the production and sale of smokeless tobacco. They say a ban on spitting in public places will also discourage smokeless tobacco use and may reduce the transmission of COVID-19.
According to material from the University of York, published in ScienceDaily, Dr Kamran Siddiqi from the Department of Health Sciences and the Hull York Medical School, said: “The study has come at a time when COVID-19 is affecting almost all aspects of our lives. Chewing tobacco increases saliva production and leads to compulsive spitting.
"There are concerns that spitting – a behaviour common among those who chew tobacco – is likely to transmit the virus to others.
"In acknowledgement of this, India for example, has already taken a positive step by banning spitting in public places to reduce the transmission of COVID-19."
The study, which was funded by the National Institute of Health Research, estimates that in 2017 alone smokeless tobacco resulted in more than 90,000 deaths due to cancers of the mouth, pharynx and oesophagus and accounted for more than 258,000 deaths from heart disease.
Millions more have their lives shortened by ill health due to the effects of chewing tobacco-based products, the study found.
Researchers compiled the figures using data from 127 countries and extracted from the 2017 Global Burden of Disease Study and surveys such as Global Adult Tobacco Survey.
Dr Siddiqi said South and South-East Asia continues to be a hotspot with India accounting for 70%, Pakistan for 7% and Bangladesh for 5% of the global disease burden due to smokeless tobacco.
He said smokeless tobacco was used by almost a quarter of tobacco users. “In the UK, South Asian communities also consume smokeless tobacco products which need to be regulated just like cigarettes."
"We have an international policy in the form of the World Health Organisation's Framework Convention for Tobacco Control, to regulate the supply and demand of tobacco products. We need to apply this framework to smokeless tobacco with the same rigour as it is applied to cigarettes."
Global burden of disease due to smokeless tobacco consumption in adults: an updated analysis of data from 127 countries
BMC Medicine, Volume 18, Article number: 222 (2020). Published on 12 August 2020.
Authors
Kamran Siddiqi, Scheherazade Husain, Aishwarya Vidyasagaran, Anne Readshaw, Masuma Pervin Mishu and Aziz Sheikh.
Department of Health Sciences at the University of York and the Usher Institute at the University of Edinburgh.
Abstract
Smokeless tobacco (ST) is consumed by more than 300 million people worldwide. The distribution, determinants and health risks of differ from that of smoking; hence, there is a need to highlight its distinct health impact. We present the latest estimates of the global burden of disease due to smokeless tobacco use.
Methods
The ST-related disease burden was estimated for all countries reporting its use among adults.
Using systematic searches, we first identified country-specific prevalence of smokeless tobacco use in men and women. We then revised our previously published disease risk estimates for oral, pharyngeal and oesophageal cancers and cardiovascular diseases by updating our systematic reviews and meta-analyses of observational studies.
The updated country-specific prevalence of smokeless tobacco and disease risk estimates, including data up to 2019, allowed us to revise the population attributable fraction (PAF) for ST for each country.
Finally, we estimated the disease burden attributable to smokeless tobacco for each country as a proportion of the DALYs lost and deaths reported in the 2017 Global Burden of Disease study. [The disability-adjusted life year is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.]
Results
Smokeless tobacco use in adults was reported in 127 countries; the highest rates of consumption were in South and Southeast Asia. The risk estimates for cancers were also highest in this region. In 2017, at least 2.5 million DALYs and 90,791 lives were lost across the globe due to oral, pharyngeal and oesophageal cancers that can be attributed to ST. Based on risk estimates obtained from the INTERHEART study, over 6 million DALYs and 258,006 lives were lost from ischaemic heart disease that can be attributed to ST. Three-quarters of the ST-related disease burden was among men. Geographically, > 85% of the ST-related burden was in South and Southeast Asia, India accounting for 70%, Pakistan for 7% and Bangladesh for 5% DALYs lost.
Conclusions
Smokeless tobacco is used across the globe and poses a major public health threat predominantly in South and Southeast Asia. While our disease risk estimates are based on a limited evidence of modest quality, the likely ST-related disease burden is substantial.
In high-burden countries, smokeless tobacco use needs to be regulated through comprehensive implementation of the World Health Organization Framework Convention for Tobacco Control.
[link url="https://www.sciencedaily.com/releases/2020/08/200813123605.htm"]Global deaths due to smokeless tobacco are up by a third, according to new study[/link]
[link url="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01677-9"]Global burden of disease due to smokeless tobacco consumption in adults: an updated analysis of data from 127 countries[/link]