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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

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dc.contributor.authorSathish, Thirunavukkarasu
dc.contributor.authorTeo, Koon
dc.contributor.authorBritz-McKibbin, Philip
dc.contributor.authorGill, Biban
dc.contributor.authorIslam, Shofiqul
dc.contributor.authorPare, Guillaume
dc.contributor.authorRangarajan, Sumathy
dc.contributor.authorDuong, MyLinh
dc.contributor.authorLanas, Fernando
dc.contributor.authorLopez-Jaramillo, Patricio
dc.contributor.authorMony, Prem
dc.contributor.authorPinnaka, Lakshmi
dc.contributor.authorRaman Kutty, Vellappillil
dc.contributor.authorOrlandini, Andres
dc.contributor.authorAvezum, Alvaro
dc.contributor.authorWielgosz, Andreas
dc.contributor.authorPoirier, Paul
dc.contributor.authorAlhabib, Khalid F.
dc.contributor.authorTemizhan, Ahmet
dc.contributor.authorChifamba, Jephat
dc.contributor.authorYeates, Karen
dc.contributor.authorKruger, Iolanthé M.
dc.contributor.authorKhatib, Rasha
dc.contributor.authorYusuf, Rita
dc.contributor.authorRosengren, Annika
dc.contributor.authorZatonska, Katarzyna
dc.contributor.authorIqbal, Romaina
dc.contributor.authorLui, Weida
dc.contributor.authorLang, Xinyue
dc.contributor.authorLi, Sidong
dc.contributor.authorHu, Bo
dc.contributor.authorDans, Antonio
dc.contributor.authorYusufali, Afzalhussein
dc.contributor.authorBahonar, Ahmad
dc.contributor.authorO’Donnell, Martin J.
dc.contributor.authorMcKee, Martin
dc.contributor.authorYusuf, Salim
dc.contributor.researchgroupMasiraspa
dc.date.accessioned2022-02-21T16:49:42Z
dc.date.available2022-02-21T16:49:42Z
dc.date.issued2022-02-24
dc.descriptionDigitalspa
dc.description.abstractBackground 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.spa
dc.description.notesFunding Full funding sources are listed at the end of the paper (see Acknowledgments).spa
dc.description.researchareaCiencias Médicas y de la Saludspa
dc.format.extent11 pspa
dc.format.mimetypeapplication/pdfspa
dc.identifier.doihttps://doi.org/10.1016/S2214-109X(21)00509-X
dc.identifier.urihttps://repositorio.udes.edu.co/handle/001/6076
dc.language.isospaspa
dc.publisherThe Lancet Global Healthspa
dc.publisher.placeReino Unidospa
dc.relation.citationendpageE226spa
dc.relation.citationissue2spa
dc.relation.citationstartpageE216spa
dc.relation.citationvolume10spa
dc.relation.indexedScopusspa
dc.relation.ispartofjournalThe Lancet Global Healthspa
dc.rights© 2021 The Author(s). Published by Elsevier Ltd.spa
dc.rights.accessrightsinfo:eu-repo/semantics/openAccessspa
dc.rights.creativecommonsAtribución-NoComercial-SinDerivadas 4.0 Internacional (CC BY-NC-ND 4.0)spa
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/spa
dc.sourcehttps://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00509-X/fulltextspa
dc.titleVariations in risks from smoking between high-income, middle-income, and low-income countries. An analysis of data from 179 000 participants from 63 countriesspa
dc.typeArtículo de revistaspa
dc.type.coarhttp://purl.org/coar/resource_type/c_6501spa
dc.type.contentTextspa
dc.type.driverinfo:eu-repo/semantics/articlespa
dc.type.redcolhttp://purl.org/redcol/resource_type/ARTspa
dc.type.versioninfo:eu-repo/semantics/publishedVersionspa
dcterms.audienceTodas las Audienciasspa
dspace.entity.typePublication
oaire.accessrightshttp://purl.org/coar/access_right/c_abf2spa
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85spa
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