Tobacco associated mortality in Mumbai (Bombay) India. Results of the Bombay Cohort Study

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Abstract
Background Little is known about the excess mortality from forms of tobacco use other than cigarette smoking that are widely prevalent in India, such as bidi smoking and the various forms of smokeless tobacco use. We report on absolute and relative risks of mortality among various kinds of ever tobacco users vs never-users in the city of Mumbai, India. Methods Using the Mumbai voters' list as the selection frame, 99 570 individuals aged ≥35 years were interviewed at their homes during 1992–94. At active follow-up (during 1997–99) after 5.5 years, 97 244 (97.7%) were traced. Among these, 7531 deaths (4119 men, 3412 women) were recorded, of which 89% died within study area. It was possible to abstract cause of death information from the records of the municipal corporation for 5470 deaths. These were coded using ICD 10. Results The adjusted relative risk was 1.37 (95% CI 1.23–1.53) for (men) cigarette smokers and 1.64 (95% CI 1.47–1.81) for bidi smokers, with a significant dose–response relationship for number of bidis or cigarettes smoked. Women were essentially smokeless tobacco users; the adjusted relative risk was 1.25 (95% CI 1.15–1.35). The risk of deaths from respiratory diseases (RR 2.12, 95% CI 1.57–2.87), tuberculosis (RR 2.30, 95% CI 1.68–3.15), and neoplasms (RR 2.60, 95% CI 1.78–3.80) were significantly high in male smokers than never tobacco users. Conclusions Bidi is no less hazardous than cigarette smoking, and smokeless tobacco use may also result in significantly increased mortality.