Bangalore: A million Indians in the productive age group of 30-69 years will die every year starting 2010 from a range of conditions caused by smoking, according to a new study released in Thursday’s issue of the New England Journal of Medicine.
The number of people who die from smoking related illnesses currently isn’t known.
The study, conducted by the Center for Global Health Research at the University of Toronto, Canada, is the first nationwide research on smoking and death in India.
Even as Indian cigarette companies lobby against having to display a symbol-based warning such as a death’s head on their packs—an attempt to reach out to illiterate customers who cannot read the statutory warnings currently printed on packs—and the country’s health ministry and Bollywood spar over the depiction of smoking and smokers in movies, the study makes it evident that India is already in the midst of an epidemic of deaths caused by smoking.
Tobacco will be responsible for one in five of all male deaths and one in 20 of all female deaths in the country by 2010, the study, A Nationally Representative Case-Control Study of Smoking and Death in India, said.
The study is also significant because it shows smoking to be the single-largest factor leading to death among people between the ages of 30 and 69. Male and female smokers in this age group, it shows, are at least 1.5 times more likely to die when compared with non-smokers.
Prabhat Jha, the lead author of the study, said the “extreme risks from smoking” were surprising even to the researchers. “Even though smoking starts at somewhat older ages in India (about 25 years) than it does in Europe and North America (about 18 years) and the average daily consumption per smoker is lower, the risks are as high as anywhere else,” added Jha.
Jha said the study found more than 50% of smoking deaths are likely to be among poor, illiterate Indians, suggesting that pictorial health warnings on packages, instead of the current written warnings, may be part of an effective anti-smoking strategy.
There are around 120 million smokers in India and more than one-third of men and around 5% of women in the 30-69 years age group smoke either cigarettes or bidis (which contain only a quarter as much tobacco as cigarettes).
According to the World Health Organization (WHO), India is home to 12% of the world’s smokers (China is home to 27%).
Health minister Anbumani Ramadoss, who has been leading a crusade against smoking in public places and the depiction of smoking in movies, said he was “alarmed” by the results. The government is “trying to take all steps to control tobacco use,” he added, particularly by informing the poor and illiterate of smoking risks.
The study covered 1.1 million homes across India and involved 900 field workers. Researchers, from teams in India, Canada and the UK, compared smoking histories of 74,000 adults who had died with 78,000 living controls. They found that among men, about 61% of smokers can expect to die between the ages of 30 and 69 compared with 41% of non-smokers. Among women, 62% of those who smoke can expect to die between the ages of 30 and 69 compared with 38% of non-smokers.
The study also shows that while there’s a rise in the number of people in urban areas who smoke, only 2% of smokers quit. “China had the same figures (2%) in 1998, but after several stringent state measures and public awareness campaigns, the percentage... has gone up to 9%,” said Jha.
Some experts say India and China have not yet fully “experienced the health impacts of increased smoking rates” and that they can curb the epidemic if they take adequate measures.
“Smoking, sugar and fat to a degree fuelled the industrial revolutions of countries such as the UK. But hopefully India will heed the lessons of Europe’s mistakes,” said David Taylor, professor of pharmacy at the University of London. Taylor has tracked the world’s tobacco habit and authored a report on this in 2007 titled Ending the Global Tobacco Pandemic.
Indians are known to be genetically more prone to cardiac disorders and diabetes than people in other countries, but if the study’s results are to be believed, smoking presents an entirely different type of health hazard. “Cigarette is potentially more lethal in India. You cannot do anything about genes, but you can surely quit smoking,” said Jha.
His study reiterates what earlier studies have shown: Tuberculosis accounts for more smoking-related deaths in rural areas and heart disease accounts for more smoking-related deaths in urban areas. “It is important to track the evolution of this epidemic in next 10 years,” Jha added.
A WHO official said the study was “very representative of India.”
“It’s going to be a good tool for advocacy and a good tool for policy in intervention,” said Poonam Khetrapal Singh, a WHO deputy regional director.
AFP contributed to this story.