Khan Zohaib, Dreger Steffen, Shah Syed Majid Hussain, Pohlabeln Hermann, Khan Sheraz, Ullah Zakir, Rehman Basheer, Zeeb Hajo
Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
Health Sciences Bremen, University of Bremen, Bremen, Germany.
PLoS One. 2017 Jul 10;12(7):e0180445. doi: 10.1371/journal.pone.0180445. eCollection 2017.
In the wake of smokeless tobacco (SLT) being advocated as a mean of tobacco harm reduction, it is pertinent to establish individual health risks associated with each SLT product. This case-control study was aimed at assessing the risk of oral cancer associated with a smokeless tobacco product (Naswar). The study was conducted from September 2014 till May 2015 in Khyber Pakhtunkhwa, Pakistan. Exposure and covariate information was collected through a structured questionnaire. Conditional logistic regression was used to calculate odds ratios (OR) along with their 95% confidence intervals (CI). 84 oral cancer cases (62% males) and 174 age- and sex-matched controls were recruited. Ever users of Naswar had more than a 20-fold higher risk of oral cancer compared to never-users (OR 21.2, 95% CI 8.4-53.8). Females had a higher risk of oral cancer with the use of Naswar (OR 29.0, 95% CI 5.4-153.9) as compared to males (OR 21.0, 95% CI 6.1-72.1). Based on this result, 68% (men) and 38% (women) of the oral cancer burden in Pakistan is attributable to Naswar. The risk estimates observed in this study are comparable to risk estimates reported by previous studies on other forms of SLT use and the risk of oral cancer in Pakistan. The exposure-response relationship also supports a strong role of Naswar in the etiology of oral cancer in Pakistan. Although still requiring further validation through independent studies, these findings may be used for smokeless tobacco control in countries where Naswar use is common.
随着无烟烟草（SLT）被倡导作为一种减少烟草危害的手段，确定与每种无烟烟草产品相关的个体健康风险变得至关重要。这项病例对照研究旨在评估与一种无烟烟草产品（纳斯瓦尔）相关的口腔癌风险。该研究于2014年9月至2015年5月在巴基斯坦开伯尔-普赫图赫瓦省进行。通过结构化问卷收集暴露和协变量信息。使用条件逻辑回归计算比值比（OR）及其95%置信区间（CI）。招募了84例口腔癌病例（62%为男性）和174例年龄和性别匹配的对照。与从不使用者相比，曾经使用过纳斯瓦尔的人患口腔癌的风险高出20倍以上（OR 21.2，95%CI 8.4 - 53.8）。与男性（OR 21.0，95%CI 6.1 - 72.1）相比，女性使用纳斯瓦尔后患口腔癌的风险更高（OR 29.0，95%CI 5.4 - 153.9）。基于这一结果，巴基斯坦68%（男性）和38%（女性）的口腔癌负担可归因于纳斯瓦尔。本研究中观察到的风险估计与先前关于其他形式无烟烟草使用和巴基斯坦口腔癌风险的研究报告的风险估计相当。暴露-反应关系也支持纳斯瓦尔在巴基斯坦口腔癌病因中起重要作用。尽管仍需要通过独立研究进一步验证，但这些发现可用于在纳斯瓦尔使用普遍的国家进行无烟烟草控制。
