Smokeless tobacco is killing thousands

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More than a quarter of a million people die each year from using smokeless tobacco, researchers at the University of York have concluded. Millions more have their lives shortened by ill health due to the effects of chewing tobacco-based products, the study reveals. Researchers say it is the first time the global impact of smokeless tobacco consumption on adults has been assessed.

The team, which included collaboration from the University of Edinburgh and Imperial College, London, says governments and public health bodies need to consider incorporating the regulation of smokeless tobacco into policy frameworks. Dr Kamran Siddiqi, senior lecturer in epidemiology and public health at the department of health sciences/Hull York Medical School, said: “It is possible that these figures are underestimated and future studies may reveal that the impact is even bigger. We need a global effort to try and address and control smokeless tobacco.”

The study, which was funded by Leeds City Council and the Medical Research Council, estimates that in 2010 alone smokeless tobacco resulted in more than 62,000 deaths due to cancers of the mouth, pharynx and oesophagus and accounted for more than 200,00 deaths from heart disease. Researchers compiled the figures using data from 113 countries and extracted from the 2010 Global Burden of Disease Study and surveys such as Global Adult Tobacco Survey.

The team says that more research is needed in countries with high levels of consumption but where figures for the relative risk of acquiring smoking-related cancers are not available. Siddiqi said South-East Asia was a hotspot and in particular India which accounts for 74% of the global disease burden. He added: “Smokeless tobacco is used by almost a quarter of tobacco users and most of them live in South-East Asia. But even in this country there are communities in east London, Leicester, Birmingham, Leeds, Bradford and Birmingham using it.

“We have got no international policy on how to regulate the production, composition, sale, labelling, packaging and marketing of smokeless tobacco products. “The international framework to control tobacco doesn’t seem to work to control smokeless tobacco. It doesn’t get the same regulation as cigarettes.

“There is a need to build on the insights obtained from efforts to reduce cigarette smoking and to investigate strategies to reduce the use of smokeless tobacco.”

Abstract
Background
Smokeless tobacco is consumed in most countries in the world. In view of its widespread use and increasing awareness of the associated risks, there is a need for a detailed assessment of its impact on health. We present the first global estimates of the burden of disease due to consumption of smokeless tobacco by adults.
Methods
The burden attributable to smokeless tobacco use in adults was estimated as a proportion of the disability-adjusted life-years (DALYs) lost and deaths reported in the 2010 Global Burden of Disease study. We used the comparative risk assessment method, which evaluates changes in population health that result from modifying a population’s exposure to a risk factor. Population exposure was extrapolated from country-specific prevalence of smokeless tobacco consumption, and changes in population health were estimated using disease-specific risk estimates (relative risks/odds ratios) associated with it. Country-specific prevalence estimates were obtained through systematically searching for all relevant studies. Disease-specific risks were estimated by conducting systematic reviews and meta-analyses based on epidemiological studies.
Results
We found adult smokeless tobacco consumption figures for 115 countries and estimated burden of disease figures for 113 of these countries. Our estimates indicate that in 2010, smokeless tobacco use led to 1.7 million DALYs lost and 62,283 deaths due to cancers of mouth, pharynx and oesophagus and, based on data from the benchmark 52 country INTERHEART study, 4.7 million DALYs lost and 204,309 deaths from ischaemic heart disease. Over 85 % of this burden was in South-East Asia.
Conclusions
Smokeless tobacco results in considerable, potentially preventable, global morbidity and mortality from cancer; estimates in relation to ischaemic heart disease need to be interpreted with more caution, but nonetheless suggest that the likely burden of disease is also substantial. The World Health Organization needs to consider incorporating regulation of smokeless tobacco into its Framework Convention for Tobacco Control.

University of York material
BMC Medicine abstract


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