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Variations in risks...
Variations in risks from smoking between high-income, middle-income, and low-income countries: an analysis of data from 179000 participants from 63 countries
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Sathish, T. (author)
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Teo, K. K. (author)
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Britz-McKibbin, P. (author)
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show more...
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Gill, B. (author)
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Islam, S. (author)
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Paré, G. (author)
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Rangarajan, S. (author)
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Duong, M. (author)
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Lanas, F. (author)
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Lopez-Jaramillo, P. (author)
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Mony, P. K. (author)
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Pinnaka, L. (author)
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Kutty, V. R. (author)
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Orlandini, A. (author)
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Avezum, A. (author)
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Wielgosz, A. (author)
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Poirier, P. (author)
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Alhabib, K. F. (author)
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Temizhan, A. (author)
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Chifamba, J. (author)
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Yeates, K. (author)
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Kruger, I. M. (author)
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Khatib, R. (author)
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Yusuf, R. (author)
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- Rosengren, Annika, 1951 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine
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Zatonska, K. (author)
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Iqbal, R. (author)
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Lui, W. (author)
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Lang, X. (author)
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Li, S. (author)
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Hu, B. (author)
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Dans, A. L. (author)
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Yusufali, A. H. (author)
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Bahonar, A. (author)
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O'Donnell, M. J. (author)
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McKee, M. (author)
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Yusuf, S. (author)
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(creator_code:org_t)
- 2022
- 2022
- English.
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In: The Lancet Global Health. - 2214-109X. ; 10:2
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https://gup.ub.gu.se...
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https://doi.org/10.1...
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Abstract
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- 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). © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences (hsv//eng)
Keyword
- carbon monoxide
- glucose
- lipid
- nicotine
- tar
- acute myeloid leukemia
- adult
- aged
- alcohol consumption
- all cause mortality
- Article
- asthma
- bidi smoking
- bladder cancer
- blood pressure
- body height
- body weight
- cardiovascular disease
- case control study
- cerebrovascular accident
- chewing tobacco
- chronic bronchitis
- chronic obstructive lung disease
- cigarette smoking
- cohort analysis
- colon cancer
- controlled study
- current smoker
- diabetes mellitus
- disease duration
- dyslipidemia
- esophagus cancer
- female
- follow up
- glucose blood level
- healthy diet
- heart failure
- heart infarction
- high income country
- human
- hypertension
- influenza
- interstitial lung disease
- larynx cancer
- liver cancer
- low income country
- lung cancer
- major clinical study
- male
- malignant neoplasm
- middle income country
- mouth cancer
- never smoker
- pancreas cancer
- pharynx cancer
- physical activity
- physical inactivity
- Piper betle
- pneumonia
- questionnaire
- rectum cancer
- respiratory tract disease
- sensitivity analysis
- smoking
- stomach cancer
- time of flight mass spectrometry
- tobacco
- tuberculosis
Publication and Content Type
- ref (subject category)
- art (subject category)
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To the university's database
- By the author/editor
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Sathish, T.
-
Teo, K. K.
-
Britz-McKibbin, ...
-
Gill, B.
-
Islam, S.
-
Paré, G.
-
show more...
-
Rangarajan, S.
-
Duong, M.
-
Lanas, F.
-
Lopez-Jaramillo, ...
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Mony, P. K.
-
Pinnaka, L.
-
Kutty, V. R.
-
Orlandini, A.
-
Avezum, A.
-
Wielgosz, A.
-
Poirier, P.
-
Alhabib, K. F.
-
Temizhan, A.
-
Chifamba, J.
-
Yeates, K.
-
Kruger, I. M.
-
Khatib, R.
-
Yusuf, R.
-
Rosengren, Annik ...
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Zatonska, K.
-
Iqbal, R.
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Lui, W.
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Lang, X.
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Li, S.
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Hu, B.
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Dans, A. L.
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Yusufali, A. H.
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Bahonar, A.
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O'Donnell, M. J.
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McKee, M.
-
Yusuf, S.
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Health Sciences
- Articles in the publication
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The Lancet Globa ...
- By the university
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University of Gothenburg