Variations in risks from smoking between high-income, middle-income, and low-income countries. An analysis of data from 179 000 participants from 63 countries
Background Separate studies suggest that the risks from smoking might vary between high-income (HICs), middle-income (MICs), and low-income (LICs) countries, but this has not yet been systematically examined within a single study using standardised approaches. We examined the variations in risks fr...
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The Lancet Global Health
2022-02-24
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Sathish, Thirunavukkarasu Teo, Koon Britz-McKibbin, Philip Gill, Biban Islam, Shofiqul Pare, Guillaume Rangarajan, Sumathy Duong, MyLinh Lanas, Fernando Lopez-Jaramillo, Patricio Mony, Prem Pinnaka, Lakshmi Raman Kutty, Vellappillil Orlandini, Andres Avezum, Alvaro Wielgosz, Andreas Poirier, Paul Alhabib, Khalid F. Temizhan, Ahmet Chifamba, Jephat Yeates, Karen Kruger, Iolanthé M. Khatib, Rasha Yusuf, Rita Rosengren, Annika Zatonska, Katarzyna Iqbal, Romaina Lui, Weida Lang, Xinyue Li, Sidong Hu, Bo Dans, Antonio Yusufali, Afzalhussein Bahonar, Ahmad O’Donnell, Martin J. McKee, Martin Yusuf, Salim Masira 2022-02-21T16:49:42Z 2022-02-21T16:49:42Z 2022-02-24 Digital Background Separate studies suggest that the risks from smoking might vary between high-income (HICs), middle-income (MICs), and low-income (LICs) countries, but this has not yet been systematically examined within a single study using standardised approaches. We examined the variations in risks from smoking across different country income groups and some of their potential reasons. Methods We analysed data from 134 909 participants from 21 countries followed up for a median of 11·3 years in the Prospective Urban Rural Epidemiology (PURE) cohort study; 9711 participants with myocardial infarction and 11 362 controls from 52 countries in the INTERHEART case-control study; and 11 580 participants with stroke and 11 331 controls from 32 countries in the INTERSTROKE case-control study. In PURE, all-cause mortality, major cardiovascular disease, cancers, respiratory diseases, and their composite were the primary outcomes for this analysis. Biochemical verification of urinary total nicotine equivalent was done in a substudy of 1000 participants in PURE. Findings In PURE, the adjusted hazard ratio (HR) for the composite outcome in current smokers (vs never smokers) was higher in HICs (HR 1·87, 95% CI 1·65–2·12) than in MICs (1·41, 1·34–1·49) and LICs (1·35, 1·25–1·46; interaction p<0·0001). Similar patterns were observed for each component of the composite outcome in PURE, myocardial infarction in INTERHEART, and stroke in INTERSTROKE. The median levels of tar, nicotine, and carbon monoxide displayed on the cigarette packs from PURE HICs were higher than those on the packs from MICs. In PURE, the proportion of never smokers reporting high second-hand smoke exposure (≥1 times/day) was 6·3% in HICs, 23·2% in MICs, and 14·0% in LICs. The adjusted geometric mean total nicotine equivalent was higher among current smokers in HICs (47·2 μM) than in MICs (31·1 μM) and LICs (25·2 μM; ANCOVA p<0·0001). By contrast, it was higher among never smokers in LICs (18·8 μM) and MICs (11·3 μM) than in HICs (5·0 μM; ANCOVA p=0·0001). Interpretation The variations in risks from smoking between country income groups are probably related to the higher exposure of tobacco-derived toxicants among smokers in HICs and higher rates of high second-hand smoke exposure among never smokers in MICs and LICs. Funding Full funding sources are listed at the end of the paper (see Acknowledgments). Ciencias Médicas y de la Salud 11 p application/pdf https://doi.org/10.1016/S2214-109X(21)00509-X https://repositorio.udes.edu.co/handle/001/6076 spa The Lancet Global Health Reino Unido E226 2 E216 10 Scopus The Lancet Global Health © 2021 The Author(s). Published by Elsevier Ltd. info:eu-repo/semantics/openAccess Atribución-NoComercial-SinDerivadas 4.0 Internacional (CC BY-NC-ND 4.0) https://creativecommons.org/licenses/by-nc-nd/4.0/ https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00509-X/fulltext Variations in risks from smoking between high-income, middle-income, and low-income countries. An analysis of data from 179 000 participants from 63 countries Artículo de revista http://purl.org/coar/resource_type/c_6501 Text info:eu-repo/semantics/article http://purl.org/redcol/resource_type/ART info:eu-repo/semantics/publishedVersion Todas las Audiencias Publication http://purl.org/coar/access_right/c_abf2 http://purl.org/coar/version/c_970fb48d4fbd8a85 |
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| title |
Variations in risks from smoking between high-income, middle-income, and low-income countries. An analysis of data from 179 000 participants from 63 countries |
| spellingShingle |
Variations in risks from smoking between high-income, middle-income, and low-income countries. An analysis of data from 179 000 participants from 63 countries Sathish, Thirunavukkarasu Teo, Koon Britz-McKibbin, Philip Gill, Biban Islam, Shofiqul Pare, Guillaume Rangarajan, Sumathy Duong, MyLinh Lanas, Fernando Lopez-Jaramillo, Patricio Mony, Prem Pinnaka, Lakshmi Raman Kutty, Vellappillil Orlandini, Andres Avezum, Alvaro Wielgosz, Andreas Poirier, Paul Alhabib, Khalid F. Temizhan, Ahmet Chifamba, Jephat Yeates, Karen Kruger, Iolanthé M. Khatib, Rasha Yusuf, Rita Rosengren, Annika Zatonska, Katarzyna Iqbal, Romaina Lui, Weida Lang, Xinyue Li, Sidong Hu, Bo Dans, Antonio Yusufali, Afzalhussein Bahonar, Ahmad O’Donnell, Martin J. McKee, Martin Yusuf, Salim Sathish, Thirunavukkarasu Teo, Koon Britz-McKibbin, Philip Gill, Biban Islam, Shofiqul Pare, Guillaume Rangarajan, Sumathy Duong, MyLinh Lanas, Fernando Lopez-Jaramillo, Patricio Mony, Prem Pinnaka, Lakshmi Raman Kutty, Vellappillil Orlandini, Andres Avezum, Alvaro Wielgosz, Andreas Poirier, Paul Alhabib, Khalid F. Temizhan, Ahmet Chifamba, Jephat Yeates, Karen Kruger, Iolanthé M. Khatib, Rasha Yusuf, Rita Rosengren, Annika Zatonska, Katarzyna Iqbal, Romaina Lui, Weida Lang, Xinyue Li, Sidong Hu, Bo Dans, Antonio Yusufali, Afzalhussein Bahonar, Ahmad O’Donnell, Martin J. McKee, Martin Yusuf, Salim Masira |
| title_short |
Variations in risks from smoking between high-income, middle-income, and low-income countries. An analysis of data from 179 000 participants from 63 countries |
| title_full |
Variations in risks from smoking between high-income, middle-income, and low-income countries. An analysis of data from 179 000 participants from 63 countries |
| title_fullStr |
Variations in risks from smoking between high-income, middle-income, and low-income countries. An analysis of data from 179 000 participants from 63 countries |
| title_full_unstemmed |
Variations in risks from smoking between high-income, middle-income, and low-income countries. An analysis of data from 179 000 participants from 63 countries |
| title_sort |
variations in risks from smoking between high-income, middle-income, and low-income countries. an analysis of data from 179 000 participants from 63 countries |
| author |
Sathish, Thirunavukkarasu Teo, Koon Britz-McKibbin, Philip Gill, Biban Islam, Shofiqul Pare, Guillaume Rangarajan, Sumathy Duong, MyLinh Lanas, Fernando Lopez-Jaramillo, Patricio Mony, Prem Pinnaka, Lakshmi Raman Kutty, Vellappillil Orlandini, Andres Avezum, Alvaro Wielgosz, Andreas Poirier, Paul Alhabib, Khalid F. Temizhan, Ahmet Chifamba, Jephat Yeates, Karen Kruger, Iolanthé M. Khatib, Rasha Yusuf, Rita Rosengren, Annika Zatonska, Katarzyna Iqbal, Romaina Lui, Weida Lang, Xinyue Li, Sidong Hu, Bo Dans, Antonio Yusufali, Afzalhussein Bahonar, Ahmad O’Donnell, Martin J. McKee, Martin Yusuf, Salim Sathish, Thirunavukkarasu Teo, Koon Britz-McKibbin, Philip Gill, Biban Islam, Shofiqul Pare, Guillaume Rangarajan, Sumathy Duong, MyLinh Lanas, Fernando Lopez-Jaramillo, Patricio Mony, Prem Pinnaka, Lakshmi Raman Kutty, Vellappillil Orlandini, Andres Avezum, Alvaro Wielgosz, Andreas Poirier, Paul Alhabib, Khalid F. Temizhan, Ahmet Chifamba, Jephat Yeates, Karen Kruger, Iolanthé M. Khatib, Rasha Yusuf, Rita Rosengren, Annika Zatonska, Katarzyna Iqbal, Romaina Lui, Weida Lang, Xinyue Li, Sidong Hu, Bo Dans, Antonio Yusufali, Afzalhussein Bahonar, Ahmad O’Donnell, Martin J. McKee, Martin Yusuf, Salim Masira |
| author_facet |
Sathish, Thirunavukkarasu Teo, Koon Britz-McKibbin, Philip Gill, Biban Islam, Shofiqul Pare, Guillaume Rangarajan, Sumathy Duong, MyLinh Lanas, Fernando Lopez-Jaramillo, Patricio Mony, Prem Pinnaka, Lakshmi Raman Kutty, Vellappillil Orlandini, Andres Avezum, Alvaro Wielgosz, Andreas Poirier, Paul Alhabib, Khalid F. Temizhan, Ahmet Chifamba, Jephat Yeates, Karen Kruger, Iolanthé M. Khatib, Rasha Yusuf, Rita Rosengren, Annika Zatonska, Katarzyna Iqbal, Romaina Lui, Weida Lang, Xinyue Li, Sidong Hu, Bo Dans, Antonio Yusufali, Afzalhussein Bahonar, Ahmad O’Donnell, Martin J. McKee, Martin Yusuf, Salim Sathish, Thirunavukkarasu Teo, Koon Britz-McKibbin, Philip Gill, Biban Islam, Shofiqul Pare, Guillaume Rangarajan, Sumathy Duong, MyLinh Lanas, Fernando Lopez-Jaramillo, Patricio Mony, Prem Pinnaka, Lakshmi Raman Kutty, Vellappillil Orlandini, Andres Avezum, Alvaro Wielgosz, Andreas Poirier, Paul Alhabib, Khalid F. Temizhan, Ahmet Chifamba, Jephat Yeates, Karen Kruger, Iolanthé M. Khatib, Rasha Yusuf, Rita Rosengren, Annika Zatonska, Katarzyna Iqbal, Romaina Lui, Weida Lang, Xinyue Li, Sidong Hu, Bo Dans, Antonio Yusufali, Afzalhussein Bahonar, Ahmad O’Donnell, Martin J. McKee, Martin Yusuf, Salim Masira |
| building |
Repositorio digital |
| publishDate |
2022-02-24 |
| language |
Español |
| publisher |
The Lancet Global Health |
| physical |
11 p |
| format |
Artículo de revista |
| description |
Background
Separate studies suggest that the risks from smoking might vary between high-income (HICs), middle-income (MICs), and low-income (LICs) countries, but this has not yet been systematically examined within a single study using standardised approaches. We examined the variations in risks from smoking across different country income groups and some of their potential reasons.
Methods
We analysed data from 134 909 participants from 21 countries followed up for a median of 11·3 years in the Prospective Urban Rural Epidemiology (PURE) cohort study; 9711 participants with myocardial infarction and 11 362 controls from 52 countries in the INTERHEART case-control study; and 11 580 participants with stroke and 11 331 controls from 32 countries in the INTERSTROKE case-control study. In PURE, all-cause mortality, major cardiovascular disease, cancers, respiratory diseases, and their composite were the primary outcomes for this analysis. Biochemical verification of urinary total nicotine equivalent was done in a substudy of 1000 participants in PURE.
Findings
In PURE, the adjusted hazard ratio (HR) for the composite outcome in current smokers (vs never smokers) was higher in HICs (HR 1·87, 95% CI 1·65–2·12) than in MICs (1·41, 1·34–1·49) and LICs (1·35, 1·25–1·46; interaction p<0·0001). Similar patterns were observed for each component of the composite outcome in PURE, myocardial infarction in INTERHEART, and stroke in INTERSTROKE. The median levels of tar, nicotine, and carbon monoxide displayed on the cigarette packs from PURE HICs were higher than those on the packs from MICs. In PURE, the proportion of never smokers reporting high second-hand smoke exposure (≥1 times/day) was 6·3% in HICs, 23·2% in MICs, and 14·0% in LICs. The adjusted geometric mean total nicotine equivalent was higher among current smokers in HICs (47·2 μM) than in MICs (31·1 μM) and LICs (25·2 μM; ANCOVA p<0·0001). By contrast, it was higher among never smokers in LICs (18·8 μM) and MICs (11·3 μM) than in HICs (5·0 μM; ANCOVA p=0·0001).
Interpretation
The variations in risks from smoking between country income groups are probably related to the higher exposure of tobacco-derived toxicants among smokers in HICs and higher rates of high second-hand smoke exposure among never smokers in MICs and LICs.
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https://repositorio.udes.edu.co/handle/001/6076 |
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