India caught in the midst of catastrophic smoking epidemic

India is caught in the midst of a catastrophic smoking epidemic, which is causing one in five of all male deaths in middle age and will cause about one million deaths a year during the 2010s.

Seventy percent of these deaths (600,000 male and 100,000 female) will be between the ages of 30 and 69.

The findings are from the first nationally representative study of smoking in India as a whole. The research, a collaboration between India, Canada and the UK, is published in the New England Journal of Medicine.

The study found that, among men, about 61 percent of those who smoke can expect to die at ages 30-69 compared with only 41 percent of otherwise similar non-smokers. Among women, 62 percent of those who smoke can expect to die at ages 30-69 compared with only 38 percent of non-smokers. This means that smoking accounts for most of the difference in premature deaths between men and women in India.

Professor Sir Richard Peto, of the Medical Research Council Clinical Trial Service Unit at the University of Oxford and one of the co-authors on the paper, said: “We were surprised by just how dangerous smoking was for Indian populations. But while smoking kills, stopping works. British studies show that stopping smoking is remarkably effective. At present, however, only 2 percent of adults have quit in India, and often only after falling ill.”

The study found there were no safe levels of smoking, but while the hazards of smoking even a few Indian roll-ups (bidis) a day were substantial, the dangers of smoking just a few cigarettes a day were even greater, corresponding to almost a doubling of the risk of death in middle age.

Sir Leszek Borysiewicz, Chief Executive of the Medical Research Council, said: “This research demonstrates the scale of the problem. It also shows that smoking kills in different ways in rural and urban India. In rural India, smoking mainly kills by causing death from TB. In Indian cities it mainly kills by causing heart attacks. This suggests a high risk of smoking-related cardiovascular disease among South Asian populations around the world. However, be it in Delhi or Derby, the same thing works: quitting. This is why the MRC is a founding member of ‘Grand Challenges in Chronic Non-Communicable Diseases' which has as one of it aims to assist in smoking cessation initiatives worldwide.”Jean King, director of tobacco control at Cancer Research UK, added: “Smokers in India have twice the non-smoker cancer rate and are twice as likely to die in middle age as non-smokers. Cancer deaths in India will continue to rise unless concerted action is taken to reduce smoking rates. It's clear that the best way for smokers to reduce their risk of cancer, and many other life threatening diseases, is to stop smoking entirely. Over the past 30 years UK smoking rates have declined and we have seen the world's biggest decrease in lung cancer deaths, particularly among men.”