Burden of total and cause-specific mortality related to tobacco smoking among adults aged ≥ 45 years in Asia: a pooled analysis of 21 cohorts

Wei Zheng, Dale F McLerran, Betsy A Rolland, Zhenming Fu, Paolo Boffetta, Jiang He, Prakash Chandra Gupta, Kunnambath Ramadas, Shoichiro Tsugane, Fujiko Irie, Akiko Tamakoshi, Yu-Tang Gao, Woon-Puay Koh, Xiao-Ou Shu, Kotaro Ozasa, Yoshikazu Nishino, Ichiro Tsuji, Hideo Tanaka, Chien-Jen Chen, Jian-Min Yuan, Yoon-Ok Ahn, Keun-Young Yoo, Habibul Ahsan, Wen-Harn Pan, You-Lin Qiao, Dongfeng Gu, Mangesh Suryakant Pednekar, Catherine Sauvaget, Norie Sawada, Toshimi Sairenchi, Gong Yang, Renwei Wang, Yong-Bing Xiang, Waka Ohishi, Masako Kakizaki, Takashi Watanabe, Isao Oze, San-Lin You, Yumi Sugawara, Lesley M Butler, Dong-Hyun Kim, Sue K Park, Faruque Parvez, Shao-Yuan Chuang, Jin-Hu Fan, Chen-Yang Shen, Yu Chen, Eric J Grant, Jung Eun Lee, Rashmi Sinha, Keitaro Matsuo, Mark Thornquist, Manami Inoue, Ziding Feng, Daehee Kang, John D Potter, Wei Zheng, Dale F McLerran, Betsy A Rolland, Zhenming Fu, Paolo Boffetta, Jiang He, Prakash Chandra Gupta, Kunnambath Ramadas, Shoichiro Tsugane, Fujiko Irie, Akiko Tamakoshi, Yu-Tang Gao, Woon-Puay Koh, Xiao-Ou Shu, Kotaro Ozasa, Yoshikazu Nishino, Ichiro Tsuji, Hideo Tanaka, Chien-Jen Chen, Jian-Min Yuan, Yoon-Ok Ahn, Keun-Young Yoo, Habibul Ahsan, Wen-Harn Pan, You-Lin Qiao, Dongfeng Gu, Mangesh Suryakant Pednekar, Catherine Sauvaget, Norie Sawada, Toshimi Sairenchi, Gong Yang, Renwei Wang, Yong-Bing Xiang, Waka Ohishi, Masako Kakizaki, Takashi Watanabe, Isao Oze, San-Lin You, Yumi Sugawara, Lesley M Butler, Dong-Hyun Kim, Sue K Park, Faruque Parvez, Shao-Yuan Chuang, Jin-Hu Fan, Chen-Yang Shen, Yu Chen, Eric J Grant, Jung Eun Lee, Rashmi Sinha, Keitaro Matsuo, Mark Thornquist, Manami Inoue, Ziding Feng, Daehee Kang, John D Potter

Abstract

Background: Tobacco smoking is a major risk factor for many diseases. We sought to quantify the burden of tobacco-smoking-related deaths in Asia, in parts of which men's smoking prevalence is among the world's highest.

Methods and findings: We performed pooled analyses of data from 1,049,929 participants in 21 cohorts in Asia to quantify the risks of total and cause-specific mortality associated with tobacco smoking using adjusted hazard ratios and their 95% confidence intervals. We then estimated smoking-related deaths among adults aged ≥45 y in 2004 in Bangladesh, India, mainland China, Japan, Republic of Korea, Singapore, and Taiwan-accounting for ∼71% of Asia's total population. An approximately 1.44-fold (95% CI = 1.37-1.51) and 1.48-fold (1.38-1.58) elevated risk of death from any cause was found in male and female ever-smokers, respectively. In 2004, active tobacco smoking accounted for approximately 15.8% (95% CI = 14.3%-17.2%) and 3.3% (2.6%-4.0%) of deaths, respectively, in men and women aged ≥45 y in the seven countries/regions combined, with a total number of estimated deaths of ∼1,575,500 (95% CI = 1,398,000-1,744,700). Among men, approximately 11.4%, 30.5%, and 19.8% of deaths due to cardiovascular diseases, cancer, and respiratory diseases, respectively, were attributable to tobacco smoking. Corresponding proportions for East Asian women were 3.7%, 4.6%, and 1.7%, respectively. The strongest association with tobacco smoking was found for lung cancer: a 3- to 4-fold elevated risk, accounting for 60.5% and 16.7% of lung cancer deaths, respectively, in Asian men and East Asian women aged ≥45 y.

Conclusions: Tobacco smoking is associated with a substantially elevated risk of mortality, accounting for approximately 2 million deaths in adults aged ≥45 y throughout Asia in 2004. It is likely that smoking-related deaths in Asia will continue to rise over the next few decades if no effective smoking control programs are implemented. Please see later in the article for the Editors' Summary.

Conflict of interest statement

The authors have declared that no competing interests exist.

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