CGHR.ORG Smoking and Death in India Prabhat Jha On behalf of the RGI-CGHR Investigators Sources of support: ICMR and RGI (India); FIC, NIH (US); IDRC &

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Presentation transcript:

CGHR.ORG Smoking and Death in India Prabhat Jha On behalf of the RGI-CGHR Investigators Sources of support: ICMR and RGI (India); FIC, NIH (US); IDRC & CIHR (Canada); CTSU, MRC & CR-UK (UK) Centre for Global Health Research (CGHR) Keenan Research Centre at the Li Ka Shing Knowledge Institute St. Michael’s Hospital, University of Toronto World Bank seminar, April 2, 2008, Washington, DC

CGHR.ORG Key messages for the individual smoker in India 1. Risk BIGGER than previously thought 2. Smoking kills EARLY: 70% smoking deaths are at ages 30-69, losing decades of good life 3. Even a FEW bidis or cigarettes per day kills 4. STOPPING SMOKING WORKS – but, less than 2% of adults in India have quit

CGHR.ORG Nationally representative sample (Sample Registration System) 6,671 of these small areas randomly chosen from all parts of India (each with about 1000 people per area)

CGHR.ORG How was the study done? 900 non-medical staff monitored 1.1 M (11 lakh) homes for three years (2001-3) All adult deaths from diseases (74,000 deaths) Obtain smoking history of the dead from living household members 2 physicians assigned underlying fatal disease (eg TB) Compare smoking history of the dead to smoking history of 78,000 living adults

CGHR.ORG What’s new about this research? Large size of study Nationally representative study of the causes of deaths in adults: results reflect the whole of India First reliable study of female deaths from smoking in India

CGHR.ORG Smoking prevalence in India Cigarette or bidi (less tobacco than a cigarette, wrapped in the leaf of another plant)

CGHR.ORG Year% men age years who smoke Increase 2006 vs M Rising prevalence among young men?

CGHR.ORG Smoking prevalence by education

CGHR.ORG Smoking prevalence by education

CGHR.ORG Indian Women aged No. of deaths studied and smoker vs nonsmoker death rate ratio (RR) Underlying fatal disease No. deaths studied % who had smoked * Smoker vs nonsmoker RR † Tuberculosis1, ( ) Respiratory disease2, ( ) Stroke1, ( ) Heart disease2, ( ) Cancers2, ( ) All diseases16, ( ) * versus 4.5% of 26,678 living women who had smoked † Risk ratio adjusted for age, alcohol use and education

CGHR.ORG Indian Men aged No. of deaths studied and smoker vs nonsmoker death rate ratio (RR) Underlying fatal disease No. deaths studied % who had smoked * Smoker vs nonsmoker RR † Tuberculosis3, ( ) Respiratory disease3, ( ) Stroke2, ( ) Heart disease5, ( ) Cancers2, ( ) All diseases25, ( ) * versus 37.0% of 31,661 living men who had smoked † Risk ratio adjusted for age, alcohol use and education

CGHR.ORG CategorySmokers (%) Risk Ratio * Residence Rural ( ) Urban ( ) Education None ( ) Primary ( ) Secondary ( ) Alcohol No ( ) Yes ( ) Total ( ) Smoker vs Nonsmoker Risk Ratio Smoking kills all categories of men results for men aged *adjusted for age, alcohol use and education

CGHR.ORG Any smoking kills *adjusted for age, alcohol use and education

CGHR.ORG Cumulative risk of death, from age 30 smokers vs nonsmokers *adjusted for age, alcohol use and education Women

CGHR.ORG *adjusted for age, alcohol use and education Men Cumulative risk of death, from age 30 smokers vs nonsmokers

CGHR.ORG *risk in the absence of other causes of death, adjusted for age, alcohol use and education Disease-specific risks of death, ages smokers vs nonsmokers * Women

CGHR.ORG Men *risk in the absence of other causes of death, adjusted for age, alcohol use and education Disease-specific risks of death, ages smokers vs nonsmokers *

CGHR.ORG Disease Women Total deaths: 2.0 M Men Total deaths:2.9 M No. (% all deaths) No. (% all deaths) Respiratory disease26, ,00031 Tuberculosis14, ,00038 Heart disease/stroke13, ,00020 Cancer9,000467,00032 TOTAL, all diseases93, ,00020 Deaths from smoking in year 2010 in India, ages 30-69, by disease

CGHR.ORG Age rangeWomenMenBoth Ages ,000579,000672,000 All adults ,000807,000935,000 Annual deaths from smoking will rise from 930,000 to 1,000,000 (10 lakh) during 2010s Deaths from smoking in year 2010 in India

CGHR.ORG Region Ex-smoking % age 30+ Women Men India Kerala* Delhi Low quit rates in India, 2004 *highest and + lowest male quit rates, respectively

CGHR.ORG INDIA: 1 million (10 lakh) smoking deaths per year during 2010s Smoking causes 10% of the 10 million (1 crore) deaths per year from all fatal disease 70% of smoking deaths are in middle age (30-69): 700,000 (7 lakh); 600,000 men and 100,000 women 20% of all adult male deaths and 5% of all adult female deaths in middle age Over 50% of smoking deaths are in illiterate adults

CGHR.ORG Key messages for the individual smoker in India 1. Risk BIGGER than previously thought 2. Smoking kills EARLY: 70% smoking deaths are at ages 30-69, losing decades of good life 3. Even a FEW bidis or cigarettes per day kills 4. STOPPING SMOKING WORKS – but, less than 2% of adults in India have quit

CGHR.ORG Press materials on: 1.NEJM Paper and Supplementary Appendix 2.Press and video releases: English, Hindi and regional languages 3.Frequently-asked questions 4.PowerPoint slides in English 5.Information about CGHR and partners News coverage of paper at :