title: Areca nut chewing and mortality in an elderly cohort study.
abstract: Compared with the well-documented association with betel-related cancer, little is known about the long-term effect of areca nut chewing on other fatal diseases. The authors' analyses were based on a population-based cohort study in Taiwan, including 4,049 participants aged 60 years or older enrolled in 1989 and 2,462 participants aged 50-66 years enrolled in 1996. Information regarding betel quid chewing and covariates was collected at baseline and was updated at subsequent interviews. Proportional hazards analysis was performed to determine the effect of chewing on all-cause and cause-specific deaths. During a mean follow-up of 9.5 years, 2,309 deaths occurred. Ever chewers were at higher risk of only total (hazard ratio = 1.19, 95% confidence interval: 1.05, 1.35) and cerebrovascular (hazard ratio = 1.66, 95% confidence interval: 1.19, 2.30) deaths. Furthermore, increased chewing-years or quid-years appeared to be associated with increased mortality risk (linear trend: p = 0.02 for total mortality and p = 0.001 for cerebrovascular mortality). The authors found that, although betel quid chewing resulted in a statistically significant increase in the risk of total and cerebrovascular deaths in the elderly population, the associations were weak and should be interpreted with caution. Further studies are needed to confirm these findings and to better understand the possible mechanisms of death.
authors.affiliation: Division of Gerontology Research, National Health Research Institutes, No. 161 Ming-Chuan East Road Section 6, Taipei 114, Taiwan. tylan@nhri.org.tw
authors.forename: Tzuo-Yun
authors.initials: TY
authors.lastname: Lan
authors.forename: Wen-Chiung
authors.initials: WC
authors.lastname: Chang
authors.forename: Yih-Jian
authors.initials: YJ
authors.lastname: Tsai
authors.forename: Yi-Li
authors.initials: YL
authors.lastname: Chuang
authors.forename: Hui-Sheng
authors.initials: HS
authors.lastname: Lin
authors.forename: Tong-Yuan
authors.initials: TY
authors.lastname: Tai
mesh_terms: D000368:Aged; D001114:Areca / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000401:mortality; D003920:Diabetes Mellitus / Q000209:etiology / Q000401:mortality; D004781:Environmental Exposure / Q000009:adverse effects / Q000706:statistics & numerical data; D016021:Epidemiologic Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008409:Mastication; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000209:etiology / Q000401:mortality; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012140:Respiratory Tract Diseases / Q000209:etiology / Q000401:mortality; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013624:Taiwan / Q000453:epidemiology