Effect of tobacco chewing, tobacco smoking and alcohol on all-cause and cancer mortality: A cohort study from Trivandrum, India

Objective To study the risk of all-cause, cancel and tobacco-related cancer mortality associated with tobacco chewing, tobacco smoking and alcohol use Design Prospective community-based cohort study initiated in 1996 Participants 167 343 adult subjects, aged 34 and older, living in 13 panchayaths (rural municipal administrative units) in South India, were regularly followed-up for a mean duration of 65 years Main outcome measures: Mortality from all-causes, all cancer and tobacco-related cancer Results The mortality risks associated with chewing (and 95% confidence intervals), after adjusting for age, sex, socio-economic and dietary variables, and for other habits, were 090 (0 86-0 94) for all-cause, 1 07 (0 94-1 22) for cancer and 1 22 (1 04-1 44) for tobacco-related cancer, with smoking the respective mortality risks were 1 31(1.24-1 39), 1 63 (1 37-1 94) and 1.68 (1.36-2 08), and with alcohol use the risks were 1 13 (1.06-1.20). 1 32 (1 11-1 57) and 1 47(1.19-1 80), respectively Reduced risk of all-cause mortality by chewing was observed only in the 60-84 years old group (0 90 (0 85-0 94)), and detrimental effects of chewing on cancer mortality were shown in the young and middle-age groups 34-39 years old (1 33 (0 67-2 65)), and 40-59 years old (1 26(1.03-1 55)) Conclusion Tobacco in any form and alcohol uses were harmful and a higher quality of life could be achieved by avoiding these habits Given the demographic, epidemiological and economic transitions and changes in pattern of tobacco and alcohol use in India, the health loss from the tobacco and alcohol will grow even larger, unless effective interventions and policies to reduce these habits are implemented (C) 2010 Elsevier Ltd All rights reserved