Tobacco use, body mass and cancer mortality in Mumbai Cohort Study

Cardiovascular Diseases in India Compared With the United States

This review describes trends in the burden of cardiovascular diseases (CVDs) and risk factors in India compared with the United States; provides potential explanations for these differences; and describes strategies to improve cardiovascular health behaviors, systems, and policies in India. The prevalence of CVD in India has risen over the past 2 decades due to population growth, aging, and a stable age-adjusted CVD mortality rate. Over the same time period, the United States has experienced an overall decline in age-adjusted CVD mortality, although the trend has begun to plateau. These improvements in CVD mortality in the United States are largely due to favorable population-level risk factor trends, specifically with regard to tobacco use, cholesterol, and blood pressure, although improvements in secondary prevention and acute care have also contributed. To realize similar gains in reducing premature death and disability from CVD, India needs to implement population-level policies while strengthening and integrating its local, regional, and national health systems. Achieving universal health coverage that includes financial risk protection should remain a goal to help all Indians realize their right to health.

Tobacco use or body mass--do they predict tuberculosis mortality in Mumbai, India? Results from a population-based cohort study

Tobacco use and under-nutrition are major public health concerns and tuberculosis is a major cause of morbidity and mortality in India. Using a cohort of 148,173 persons (recruited 1991-1997 and followed-up 1997-2003) the joint effects of tobacco use and BMI on tuberculosis mortality was studied. Tobacco use in any form and low-BMI had joint effect on tuberculosis mortality and the interaction effect was synergistic in men and antagonistic in women. Self-reported tuberculosis was associated with increased risk of tuberculosis mortality. In contrast, no such association was observed for self-reported diabetes persons. The risk pattern remained unchanged even after excluding tuberculosis deaths occurred within 1(st) two years of follow-up. This study highlights importance of age consideration of individual while excluding early deaths. Around 27% male tuberculosis deaths were attributable to their being underweight and smoker, while 22% male and 37% female deaths were attributable to their being underweight and smokeless tobacco user.

Association of alcohol, alcohol and tobacco with mortality: findings from a prospective cohort study in Mumbai (Bombay), India

The aim of the present study was to examine the association between alcohol, alcohol and tobacco, and mortality in a large adult population in the city of Mumbai. A total of 35,102 men aged 45 years and older were surveyed about their alcohol drinking as part of a cohort study. These respondents were followed up over time, and all deaths were recorded. Compared with those who never drank alcohol, alcohol drinkers had 1.22 times higher risk of mortality, with the highest risk observed for liver disease (hazard ratio [HR]=3.19). Among ever drinkers, risk of mortality varied according to types (country/desi), frequency (four or less times a week, HR=1.39), and quantity of alcohol consumed (>100 mL) per day. In addition, country/desi drinkers (HR=1.34) had the highest mortality risk compared with all other types of alcohol (HR=0.97). Alcohol drinkers had increased risk of mortality for tuberculosis (HR=2.53), cerebrovascular disease (HR=1.83), and liver disease (HR=3.19). Synergistic joint effect of tobacco and alcohol on mortality was also observed, with lowest risk in never tobacco user drinkers (HR=1.02) and highest in mixed tobacco user drinkers (HR=1.79). The results of this study show a direct association between greater consumption of alcohol and increased risk of mortality from alcohol-specific causes. In addition to individual effect, this study demonstrates the synergistic interaction between alcohol and tobacco use in various forms on mortality.

Assessment of follow-up, and the completeness and accuracy of cancer case ascertainment in three areas of India

BACKGROUND

A prospective study of diet and cancer has not been conducted in India; consequently, little is known regarding follow-up rates or the completeness and accuracy of cancer case ascertainment.

METHODS

We assessed follow-up in the India Health Study (IHS; 4671 participants aged 35-69 residing in New Delhi, Mumbai, or Trivandrum). We evaluated the impact of medical care access and relocation, re-contacted the IHS participants to estimate follow-up rates, and conducted separate studies of cancer cases to evaluate registry coverage (604 cases in Trivandrum) and the accuracy of self- and proxy-reporting (1600 cases in New Delhi and Trivandrum).

RESULTS

Over 97% of people reported seeing a doctor and 85% had lived in their current residence for over six years. The 2-year follow-up rate was 91% for Trivandrum and 53% for New Delhi. No cancer cases were missed among public institutions participating in the surveillance program in Trivandrum during 2003-2004; but there are likely to be unmatched cases (ranging from 5 to 13% of total cases) from private hospitals in the Trivandrum registry, as there are no mandatory reporting requirements. Vital status was obtained for 36% of cancer cases in New Delhi as compared to 78% in Trivandrum after a period of 4 years.

CONCLUSIONS

A prospective cohort study of cancer may be feasible in some centers in India with active follow-up to supplement registry data. Inclusion of cancers diagnosed at private institutions, unique identifiers for individuals, and computerized medical information would likely improve cancer registries.

Forced expiratory volume predicts all-cause and cancer mortality in Mumbai, India: results from a population-based cohort study

BACKGROUND

Reduction in pulmonary function, as estimated by forced expiratory volume in 1 s (FEV(1)), has been found to predict all-cause mortality in developed-country populations. This study was designed to examine the association between FEV(1) and mortality in an urban developing-country population.

METHODS

Data from the large, well-characterized Mumbai Cohort Study (Maharashtra, India) were used to compute hazard ratios (HRs; deaths/100-ml FEV(1)) and 95% confidence intervals (CIs) from Cox proportional hazards regression models in which age, tobacco use, education, height and relative body weight were controlled.

RESULTS

A total of 13,261 deaths occurred in this cohort of 148,173 individuals. After controlling for important covariates, there was a 1.7% reduction in risk of overall death in women for each 100-ml increment in FEV(1) (HR = 0.983; 95% CI = 0.980-0.986) and a 1.5% reduction in men (HR = 0.985; 95% CI = 0.984-0.986). There was a 1.6% reduction in cancer deaths in women (HR = 0.984; 95% CI = 0.973-0.996) and a 0.8% reduction in men (HR = 0.992; 95% CI = 0.987-0.997). The largest reductions in women were observed in tuberculosis deaths (3.7%/100-ml increment in FEV(1)), and in men in respiratory system deaths (3.2%).

CONCLUSIONS

In a densely populated urban Indian population, FEV(1) predicted overall and cancer mortality. Effects were larger in women and were not attenuated by exclusion of smokers or restricting analyses to subjects dying >2 years from recruitment. Because FEV(1) may be affected by air pollution, which is worsening in urban areas of most developing countries, further research is recommended to deepen understanding of these factors in relation to mortality.