Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK.
Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
BMC Med. 2020 Aug 12;18(1):222. doi: 10.1186/s12916-020-01677-9.
Smokeless tobacco (ST) is consumed by more than 300 million people worldwide. The distribution, determinants and health risks of ST differ from that of smoking; hence, there is a need to highlight its distinct health impact. We present the latest estimates of the global burden of disease due to ST use.
The ST-related disease burden was estimated for all countries reporting its use among adults. Using systematic searches, we first identified country-specific prevalence of ST use in men and women. We then revised our previously published disease risk estimates for oral, pharyngeal and oesophageal cancers and cardiovascular diseases by updating our systematic reviews and meta-analyses of observational studies. The updated country-specific prevalence of ST and disease risk estimates, including data up to 2019, allowed us to revise the population attributable fraction (PAF) for ST for each country. Finally, we estimated the disease burden attributable to ST for each country as a proportion of the DALYs lost and deaths reported in the 2017 Global Burden of Disease study.
ST use in adults was reported in 127 countries; the highest rates of consumption were in South and Southeast Asia. The risk estimates for cancers were also highest in this region. In 2017, at least 2.5 million DALYs and 90,791 lives were lost across the globe due to oral, pharyngeal and oesophageal cancers that can be attributed to ST. Based on risk estimates obtained from the INTERHEART study, over 6 million DALYs and 258,006 lives were lost from ischaemic heart disease that can be attributed to ST. Three-quarters of the ST-related disease burden was among men. Geographically, > 85% of the ST-related burden was in South and Southeast Asia, India accounting for 70%, Pakistan for 7% and Bangladesh for 5% DALYs lost.
ST is used across the globe and poses a major public health threat predominantly in South and Southeast Asia. While our disease risk estimates are based on a limited evidence of modest quality, the likely ST-related disease burden is substantial. In high-burden countries, ST use needs to be regulated through comprehensive implementation of the World Health Organization Framework Convention for Tobacco Control.
全球有超过 3 亿人使用无烟烟草（ST）。ST 的分布、决定因素和健康风险与吸烟不同；因此，有必要强调其独特的健康影响。我们呈现了最新的全球因 ST 使用而导致的疾病负担估计。
我们对报告成人 ST 使用情况的所有国家进行了 ST 相关疾病负担估计。通过系统搜索，我们首先确定了男性和女性中 ST 使用的特定国家流行率。然后，我们通过更新我们对观察性研究的系统综述和荟萃分析，修订了我们以前发表的口腔、咽和食管癌症和心血管疾病的疾病风险估计。更新的特定国家 ST 流行率和疾病风险估计，包括截至 2019 年的数据，使我们能够修订每个国家的 ST 人群归因分数（PAF）。最后，我们将 ST 导致的疾病负担占 2017 年全球疾病负担研究报告的 DALY 损失和死亡的比例进行了估计。
127 个国家报告了成人 ST 使用情况；消费量最高的是南亚和东南亚。该地区癌症风险估计也最高。2017 年，全球因可归因于 ST 的口腔、咽和食管癌症导致至少 250 万人失去 DALY 和 90791 人死亡。根据 INTERHEART 研究获得的风险估计，全球有超过 600 万人因可归因于 ST 的缺血性心脏病失去 DALY 和 258006 人死亡。四分之三的 ST 相关疾病负担发生在男性中。在地理上，超过四分之三的 ST 相关负担发生在南亚和东南亚，印度占 70%，巴基斯坦占 7%，孟加拉国占 5%。
ST 在全球范围内被使用，并主要在南亚和东南亚构成重大公共卫生威胁。虽然我们的疾病风险估计基于有限的低质量证据，但可能的 ST 相关疾病负担是相当大的。在高负担国家，需要通过全面实施世界卫生组织烟草控制框架公约来规范 ST 使用。
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