A Nationally Representative Case–Control Study of Smoking and Death in India

TLDR

Smoking mortality in India has been poorly quantified, yet a 1.1‑million‑home survey shows it causes nearly a million deaths annually, with 70 % of those aged 30‑69 and numbers rising 3 % per year. The study used a nationally representative case‑control design, comparing smoking prevalence in 33,000 deceased women and 41,000 deceased men to 35,000 living women and 43,000 living men, and adjusted mortality risk ratios for age, education, and alcohol use. Smokers aged 30‑69 had a 2.0× higher risk of death among women and 1.7× among men, with excess mortality mainly from tuberculosis (RR ≈ 3.0 women, 2.3 men) and other diseases; smoking shortened median survival by 8 years for women and 6 years for men, accounting for about 1 in 20 female and 1 in 5 male deaths.

Abstract

The nationwide effects of smoking on mortality in India have not been assessed reliably.In a nationally representative sample of 1.1 million homes, we compared the prevalence of smoking among 33,000 deceased women and 41,000 deceased men (case subjects) with the prevalence of smoking among 35,000 living women and 43,000 living men (unmatched control subjects). Mortality risk ratios comparing smokers with nonsmokers were adjusted for age, educational level, and use of alcohol.About 5% of female control subjects and 37% of male control subjects between the ages of 30 and 69 years were smokers. In this age group, smoking was associated with an increased risk of death from any medical cause among both women (risk ratio, 2.0; 99% confidence interval [CI], 1.8 to 2.3) and men (risk ratio, 1.7; 99% CI, 1.6 to 1.8). Daily smoking of even a small amount of tobacco was associated with increased mortality. Excess deaths among smokers, as compared with nonsmokers, were chiefly from tuberculosis among both women (risk ratio, 3.0; 99% CI, 2.4 to 3.9) and men (risk ratio, 2.3; 99% CI, 2.1 to 2.6) and from respiratory, vascular, or neoplastic disease. Smoking was associated with a reduction in median survival of 8 years for women (99% CI, 5 to 11) and 6 years for men (99% CI, 5 to 7). If these associations are mainly causal, smoking in persons between the ages of 30 and 69 years is responsible for about 1 in 20 deaths of women and 1 in 5 deaths of men. In 2010, smoking will cause about 930,000 adult deaths in India; of the dead, about 70% (90,000 women and 580,000 men) will be between the ages of 30 and 69 years. Because of population growth, the absolute number of deaths in this age group is rising by about 3% per year.Smoking causes a large and growing number of premature deaths in India.