MyLinh Duong1, Sumathy Rangarajan2, Xiaohe Zhang2, Kieran Killian3, Prem Mony4, Sumathi Swaminathan4, Ankalmadagu Venkatsubbareddy Bharathi4, Sanjeev Nair5, Krishnapillai Vijayakumar6, Indu Mohan7, Rajeev Gupta7, Deepa Mohan8, Shanthi Rani8, Viswanathan Mohan8, Romaina Iqbal9, Khawar Kazmi10, Omar Rahman11, Rita Yusuf11, Lakshmi Venkata Maha Pinnaka12, Rajesh Kumar12, Paul O'Byrne3, Salim Yusuf13. 1. Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada. Electronic address: duongmy@mcmaster.ca. 2. Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada. 3. Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada. 4. Division of Epidemiology and Population Health, St John's Research Institute, Bengaluru, India. 5. Department of Pulmonary Medicine, Medical College, Thiruvananthapuram, Kerala, India; Health Action by People, Thiruvananthapuram, Kerala, India. 6. Health Action by People, Thiruvananthapuram, Kerala, India; Dr Somervell Memorial CSI Medical College, Karakonam, Thiruvananthapuram, Kerala, India. 7. Fortis Escorts Hospitals, JLN Marg, Jaipur, India. 8. Madras Diabetes Research Foundation, Chennai, India. 9. Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan; Department of Medicine, Aga Khan University, Karachi, Pakistan. 10. Department of Medicine, Aga Khan University, Karachi, Pakistan. 11. Independent University, Dhaka, Bangladesh. 12. Post Graduate Institute of Medical Education and Research (PGIMER) School of Public Health, Chandigarh, India. 13. Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
Abstract
BACKGROUND: Bidis are minimally regulated, inexpensive, hand-rolled tobacco products smoked in south Asia. We examined the effects of bidi smoking on baseline respiratory impairment, and prospectively collected data for all-cause mortality and cardiorespiratory events in men from this region. METHODS: This substudy of the international, community-based Prospective Urban Rural Epidemiology (PURE) study was done in seven centres in India, Pakistan, and Bangladesh. Men aged 35-70 years completed spirometry testing and standardised questionnaires at baseline and were followed up yearly. We used multilevel regression to compare cross-sectional baseline cardiorespiratory symptoms, spirometry measurements, and follow-up events (all-cause mortality, cardiovascular events, respiratory events) adjusted for socioeconomic status and baseline risk factors between non-smokers, light smokers of bidis or cigarettes (≤10 pack-years), heavy smokers of cigarettes only (>10 pack-years), and heavy smokers of bidis (>10 pack-years). FINDINGS: 14 919 men from 158 communities were included in this substudy (8438 non-smokers, 3321 light smokers, 959 heavy cigarette smokers, and 2201 heavy bidi smokers). Mean duration of follow-up was 5·6 years (range 1-13). The adjusted prevalence of self-reported chronic wheeze, cough or sputum, dyspnoea, and chest pain at baseline increased across the categories of non-smokers, light smokers, heavy cigarette smokers, and heavy bidi smokers (p<0·0001 for association). Adjusted cross-sectional age-related changes in forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity (FVC) ratio were larger for heavy bidi smokers than for the other smoking categories. Hazard ratios (relative to non-smokers) showed increasing hazards for all-cause mortality (light smokers 1·28 [95% CI 1·02-1·62], heavy cigarette smokers 1·59 [1·13-2·24], heavy bidi smokers 1·56 [1·22-1·98]), cardiovascular events (1·45 [1·13-1·84], 1·47 [1·05-2·06], 1·55 [1·17-2·06], respectively) and respiratory events (1·30 [0·91-1·85], 1·21 [0·70-2·07], 1·73 [1·23-2·45], respectively) across the smoking categories. INTERPRETATION: Bidi smoking is associated with severe baseline respiratory impairment, all-cause mortality, and cardiorespiratory outcomes. Stricter controls and regulation of bidis are needed to reduce the tobacco-related disease burden in south Asia. FUNDING: Population Health Research Institute, Canadian Institutes of Health Research, and Heart and Stroke Foundation of Ontario.
BACKGROUND: Bidis are minimally regulated, inexpensive, hand-rolled tobacco products smoked in south Asia. We examined the effects of bidi smoking on baseline respiratory impairment, and prospectively collected data for all-cause mortality and cardiorespiratory events in men from this region. METHODS: This substudy of the international, community-based Prospective Urban Rural Epidemiology (PURE) study was done in seven centres in India, Pakistan, and Bangladesh. Men aged 35-70 years completed spirometry testing and standardised questionnaires at baseline and were followed up yearly. We used multilevel regression to compare cross-sectional baseline cardiorespiratory symptoms, spirometry measurements, and follow-up events (all-cause mortality, cardiovascular events, respiratory events) adjusted for socioeconomic status and baseline risk factors between non-smokers, light smokers of bidis or cigarettes (≤10 pack-years), heavy smokers of cigarettes only (>10 pack-years), and heavy smokers of bidis (>10 pack-years). FINDINGS: 14 919 men from 158 communities were included in this substudy (8438 non-smokers, 3321 light smokers, 959 heavy cigarette smokers, and 2201 heavy bidi smokers). Mean duration of follow-up was 5·6 years (range 1-13). The adjusted prevalence of self-reported chronic wheeze, cough or sputum, dyspnoea, and chest pain at baseline increased across the categories of non-smokers, light smokers, heavy cigarette smokers, and heavy bidi smokers (p<0·0001 for association). Adjusted cross-sectional age-related changes in forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity (FVC) ratio were larger for heavy bidi smokers than for the other smoking categories. Hazard ratios (relative to non-smokers) showed increasing hazards for all-cause mortality (light smokers 1·28 [95% CI 1·02-1·62], heavy cigarette smokers 1·59 [1·13-2·24], heavy bidi smokers 1·56 [1·22-1·98]), cardiovascular events (1·45 [1·13-1·84], 1·47 [1·05-2·06], 1·55 [1·17-2·06], respectively) and respiratory events (1·30 [0·91-1·85], 1·21 [0·70-2·07], 1·73 [1·23-2·45], respectively) across the smoking categories. INTERPRETATION: Bidi smoking is associated with severe baseline respiratory impairment, all-cause mortality, and cardiorespiratory outcomes. Stricter controls and regulation of bidis are needed to reduce the tobacco-related disease burden in south Asia. FUNDING: Population Health Research Institute, Canadian Institutes of Health Research, and Heart and Stroke Foundation of Ontario.
Authors: Vanessa Cardoso Pereira; David Lopes Lima Cavalcanti Coelho; Juracy Marques Dos Santos; Dinani Matoso Fialho de Oliveira Armstrong; Pedro Vinícius Amorim de Medeiros Patriota; João Augusto Costa Lima; Álvaro Augusto Cruz; Rodrigo Feliciano do Carmo; Carlos Dornels Freire de Souza; Anderson da Costa Armstrong Journal: J Bras Pneumol Date: 2022-05-13 Impact factor: 2.624
Authors: Padmanabhan Arjun; Sanjeev Nair; G Jilisha; Jyolsna Anand; Veena Babu; Hisham Moosan; Anitha K Kumari Journal: J Family Med Prim Care Date: 2019-08-28