title: A nationally representative case-control study of smoking and death in India.
abstract: BACKGROUND
  The nationwide effects of smoking on mortality in India have not been assessed reliably.
  
  
  METHODS
  In a nationally representative sample of 1.1 million homes, we compared the prevalence of smoking among 33,000 deceased women and 41,000 deceased men (case subjects) with the prevalence of smoking among 35,000 living women and 43,000 living men (unmatched control subjects). Mortality risk ratios comparing smokers with nonsmokers were adjusted for age, educational level, and use of alcohol.
  
  
  RESULTS
  About 5% of female control subjects and 37% of male control subjects between the ages of 30 and 69 years were smokers. In this age group, smoking was associated with an increased risk of death from any medical cause among both women (risk ratio, 2.0; 99% confidence interval [CI], 1.8 to 2.3) and men (risk ratio, 1.7; 99% CI, 1.6 to 1.8). Daily smoking of even a small amount of tobacco was associated with increased mortality. Excess deaths among smokers, as compared with nonsmokers, were chiefly from tuberculosis among both women (risk ratio, 3.0; 99% CI, 2.4 to 3.9) and men (risk ratio, 2.3; 99% CI, 2.1 to 2.6) and from respiratory, vascular, or neoplastic disease. Smoking was associated with a reduction in median survival of 8 years for women (99% CI, 5 to 11) and 6 years for men (99% CI, 5 to 7). If these associations are mainly causal, smoking in persons between the ages of 30 and 69 years is responsible for about 1 in 20 deaths of women and 1 in 5 deaths of men. In 2010, smoking will cause about 930,000 adult deaths in India; of the dead, about 70% (90,000 women and 580,000 men) will be between the ages of 30 and 69 years. Because of population growth, the absolute number of deaths in this age group is rising by about 3% per year.
  
  
  CONCLUSIONS
  Smoking causes a large and growing number of premature deaths in India.
authors.affiliation: Centre for Global Health Research, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. prabhat.jha@utoronto.ca
authors.forename: Prabhat
authors.initials: P
authors.lastname: Jha
authors.forename: Binu
authors.initials: B
authors.lastname: Jacob
authors.forename: Vendhan
authors.initials: V
authors.lastname: Gajalakshmi
authors.forename: Prakash C
authors.initials: PC
authors.lastname: Gupta
authors.forename: Neeraj
authors.initials: N
authors.lastname: Dhingra
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
authors.forename: Dhirendra N
authors.initials: DN
authors.lastname: Sinha
authors.forename: Rajesh P
authors.initials: RP
authors.lastname: Dikshit
authors.forename: Dillip K
authors.initials: DK
authors.lastname: Parida
authors.forename: Rajeev
authors.initials: R
authors.lastname: Kamadod
authors.forename: Jillian
authors.initials: J
authors.lastname: Boreham
authors.forename: Richard
authors.initials: R
authors.lastname: Peto
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002423:Cause of Death; D005260:Female; D006306:Health Surveys; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012306:Risk; D012907:Smoking / Q000401:mortality*