Tobacco and Alcohol Associated Mortality among Men by Socio-Economic Status in India

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Authors

  • Mangesh S. Pednekar Healis Sekhsaria Institute for Public Health, Mahape, Navi Mumbai, India
  • Jooi Vasa Healis Sekhsaria Institute for Public Health, Mahape, Navi Mumbai, India
  • Sameer S. Narake Healis Sekhsaria Institute for Public Health, Mahape, Navi Mumbai, India
  • Dhirendra N. Sinha School of Preventive Oncology, Patna, India
  • Prakash C. Gupta Healis Sekhsaria Institute for Public Health, Mahape, Navi Mumbai, India

DOI:

https://doi.org/10.17140/EPOJ-1-102

Keywords:

Alcohol, India, Mortality, Risk ratios, Smokeless tobacco, Smoking, Socioeco nomic status

Abstract

Background: Tobacco use, alcohol use and Socioeconomic status (SES) are all strongly associated with mortality. These risk factors however, are also strongly associated with each other. The effect of the interrelationship between these risk factors on mortality has not been examined in India.
Objectives: To study tobacco and alcohol associated Hazard Ratios (HRs) stratified by SES.
Methods: A cohort of 34,055 men (age>=45 years) was recruited through house visits and information collected through face-to-face interviews during 1994 to 1997. During 1999 to 2003, follow-up through repeat house visits was conducted and deaths were recorded. Education level was used as proxy for SES. Cox proportional hazards model provided HRs and 95% Confidence Intervals (CIs) for tobacco/alcohol associated mortality adjusted for alcohol/tobacco and other confounders. Additionally, HRs was stratified by SES for their individual (tobacco, alcohol use) and their joint effect on mortality.
Results: For tobacco associated mortality, stratification by SES showed higher HRs for high SES bidi smokers (HR=2.01) compared to corresponding low SES bidi smokers (HR=1.41). For alcohol associated mortality, HRs were higher among high SES ‘country/desi’ drinkers (HR=1.56) compared to corresponding low SES counterpart (HR=1.31). After adjusting for alcohol exposure, the highest attenuation of HRs (>20%) for tobacco associated mortality was observed for deaths from tuberculosis and digestive system diseases (mainly liver diseases) among various forms of tobacco users.
Conclusions: The examination of differences in mortality risks by SES, showing higher HRs among high SES bidi smokers and high SES ‘country/desi’ drinkers, have implications for public health policies.

References

World Health Organization. WHO report on the global to-bacco epidemic 2013: enforcing bans on tobacco advertising, promotion, and sponsorship. http://apps.who.int/iris/bitstre am/10665/85380/1/9789241505871_eng.pdf. Published 2013. Accessed February 10, 2016.

World Health Organization. Global status report on noncom-minicable diseases 2010. http://www.who.int/nmh/publications/ ncd_report_full_en.pdf. Published 2010. Accessed February 10, 2016.

Institute for Health Metrics and Evaluation. The Global Burden of Disease: Generating Evidence, Guiding Policy. Se-attle, WA, USA. http://www.healthdata.org/sites/default/files/ files/data_for_download/2013/WorldBank_SubSaharanAfrica/ IHME_GBD_WorldBank_SubSaharanAfrica_FullReport.pdf. Published 2010. Accessed February 10, 2016.

Ministry of Health and Family Welfare, Government of India. Global Adult Tobacco Survey - India, 2009-2010. India: MO-HFW, Mumbai. Web site. http://mohfw.nic.in/WriteReadData/ l892s/1455618937GATS%20India.pdf. Published 2010. Ac-cessed February 10, 2016.

Prabhakar B, Narake SS, Pednekar MS. Social disparities in tobacco use in India: the roles of occupation, education and gen-der. Indian J Cancer. 2012; 49(4): 401-409. doi: 10.4103/0019- 509X.107747

Sorensen G, Gupta PC, Pednekar MS. Social disparities in tobacco use in Mumbai, India: the roles of occupation, education and gender. Am J Public Health. 2005; 95(6): 1003-1008. doi: 10.2105/AJPH.2004.045039

Gupta PC. Survey of sociodemographic characteristics of tobacco use among 99 598 individuals in Bombay, India using handheld computers. Tob Control. 1996; 5(2): 114-120.

Gupta PC, Pednekar MS, Parkin DM, Sankaranarayanan R. Tobacco associated mortality in Mumbai (Bombay) India. Re-sults of the Bombay Cohort Study. Int J Epidemiol. 2005; 34(6): 1395-1402. doi: 10.1093/ije/dyi196

Pednekar MS, Sansone G, Gupta PC. Association of alcohol, alcohol and tobacco with mortality: findings from a prospective cohort study in Mumbai (Bombay), India. Alcohol. 2012; 46(2): 139-146. doi: 10.1016/j.alcohol.2011.08.006

Gupta PC, Maulik PK, Pednekar MS, Saxena S. Concurrent alcohol and tobacco use among a middle-aged and elderly popu-lation in Mumbai. Natl Med J India. 2005; 18(2): 88-91.

Gupta PC, Saxena S, Pednekar MS, Maulik PB. Alcohol con-sumption among middle aged and elderly men: A community study from Western India. Alcohol Alcohol. 2003; 38(4): 327- 331. doi: 10.1093/alcalc/agg077

Adler NE, Boyce T, Chesney MA, et al. Socioeconomic sta-tus and health, the challenge of the gradient. Am Psychol. 1994; 49(1): 15-24. doi: 10.1037/0003-066X.49.1.15

Adler NE, Newman K. Socioeconomic disparities in health: pathways and policies. Health Aff (Millwood). 2002; 21(2): 60- 76. doi: 10.1377/hlthaff.21.2.60

Cutler DM, Lleras-Muney A, Vogl T. Socioeconomic status and health: dimensions and mechanisms. http://www.nber.org/ papers/w14333. National Bureau of Economic Research work-ing paper 14333. Published September 2008. Accessed February 10, 2016.

Williams DR, Collings C. US socioeconomic and racial dif-ferences in health: patterns and explanations. Annu Rev Sociol. 1995; 21: 349-386. https://sph.umich.edu/sep/downloads/Wil-liams_and_Collins.pdf. Accessed February 10, 2016.

Galobardes B, Lynch J, Smith GD. Measuring socioeconom-ic position in health research. Br Med Bull. 2007; 81-82: 21-37. doi: 10.1093/bmb/ldm001

Lantz PM, Lynch JW, House JS, et al. Socioeconomic dis-parities in health change in longitudinal study of US adults: the role of health-risk behaviours. Soc Sci Med. 2001; 29-40. doi: 10.1016/S0277-9536(00)00319-1

Rani M, Bonu S, Jha P, Nguyen SN, Jamjoum L. Tobacco use in India: prevalence and predictors of smoking and chew-ing in a national cross sectional household survey. Tob Control. 2003; 12:e4. doi: 10.1136/tc.12.4.e4

Subramanian SV, Smith GD, Subramanyam M. Indigenous health and socioeconomic status in India. PLoS Med. 2006; 3(10): 1794-1804. doi: 10.1371/journal.pmed.0030421

Gajalaksmi V, Whitlock G, Peto R. Social inequalities, to-bacco chewing, and cancer mortality in south India: a case-con-trol analysis of 2,580 cancer deaths among non-smoking non-drinkers. Cancer Causes Control. 2012; 23 Suppl 1: 91-98. doi: 10.1007/s10552-012-9905-1

Rahu K, Parna K, Palo E, Rahu M. Contrasts in alcohol-related mortality in Estonia: education and ethnicity. Alcohol Al-cohol. 2009; 44(5): 517-522. doi: 10.1093/alcalc/agp035

Pridemore WA, Tomkins S, Eckhardt K, Kiryanov N, Sabu-rova L. A case-control analysis of socio-economic and marital status differentials in alcohol and non-alcohol related mortality among working-age Russian males. Eur J Public Health. 2010; 20(5): 569-575. doi: 10.1093/eurpub/ckq019

Tjepkema M, Wilkins R, Long A. Cause-specific mortality by education in Canada: a 16-year follow-up study. Health Rep. 2012; 23(3): 23-31.

Jha P, Jacob B, Gajalakshmi V, et al. A Nationally Representa-tive Case–Control Study of Smoking and Death in India. N Engl J Med. 2008; 358: 1137-1147. doi: 10.1056/NEJMsa0707719

Vineis P, Alavanja M, Buffler P, et al. Tobacco and cancer: recent epidemiological evidence. J Natl Cancer Inst. 2004; 96(2): 99-106. doi: 10.1093/jnci/djh014

Ramadas K, Sauvaget C, Thomas G, Fayette JM, Thara S, Sankaranarayanan R. Effect of tobacco chewing, tobacco smok-ing and alcohol on all-cause and cancer mortality: A cohort study from Trivandrum, India. Cancer Epidemiol. 2010; 34(4): 405- 426. doi: 10.1016/j.canep.2010.04.006

Gu D, Kelly TN, Wu X, et al. Mortality Attributable to Smok-ing in China. N Engl J Med. 2009; 360: 150-159. doi: 10.1056/ NEJMsa0802902

Gajalakshmi V, Peto R, KanakaTS, Jha P. Smoking and mor-tality from tuberculosis and other diseases in India: retrospective study of 43 000 adult male deaths and 35000 controls. Lancet. 2003;362(9383):507-515.doi:10.1016/S0140-6736(03)14109-8

Thun MJ, Apicella LF, Henley SJ. Smoking vs other risk factors as the cause of smoking-attributable deaths: confounding in the courtroom. JAMA. 2000; 284(6): 706-712. doi: 10.1001/ jama.284.6.706

Henley SJ, Thun MJ, Connell C, Calle EE. Two large pro-spective studies of mortality among men who use snuff or chew-ing tobacco (United States). Cancer Causes Control. 2005; 16: 347-358. doi: 10.1007/s10552-004-5519-6

Ministry of Health and Family Welfare Government of In-dia. International Institute for Population Sciences, Deonar, Mumbai. National Family Health Survey (NFHS-3), 2005–06: Volume 1. https://dhsprogram.com/pubs/pdf/FRIND3/FRIND3- Vol1AndVol2.pdf. Published September 2007. Accessed Febru-ary 10, 2016.

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Published

2016-03-07

How to Cite

Mangesh S. Pednekar, Jooi Vasa, Sameer S. Narake, Dhirendra N. Sinha, & Prakash C. Gupta. (2016). Tobacco and Alcohol Associated Mortality among Men by Socio-Economic Status in India. Epidemiology, 1(1), 2–15. https://doi.org/10.17140/EPOJ-1-102

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Vol. 1 No. 1 (2016): Volume 1 Issue 1 2016

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