title: A prospective study of tobacco smoking and mortality in Bangladesh.
abstract: BACKGROUND
  Limited data are available on smoking-related mortality in low-income countries, where both chronic disease burden and prevalence of smoking are increasing.
  
  
  METHODS
  Using data on 20,033 individuals in the Health Effects of Arsenic Longitudinal Study (HEALS) in Bangladesh, we prospectively evaluated the association between tobacco smoking and all-cause, cancer, and cardiovascular disease mortality during ∼7.6 years of follow-up. Cox proportional hazards models were used to estimate hazard ratios (HRs) and their 95% confidence intervals (CIs) for deaths from all-cause, cancer, CVD, ischemic heart disease (IHD), and stroke, in relation to status, duration, and intensity of cigarette/bidi and hookah smoking.
  
  
  RESULTS
  Among men, cigarette/bidi smoking was positively associated with all-cause (HR 1.40, 95% CI 1.06 1.86) and cancer mortality (HR 2.91, 1.24 6.80), and there was a dose-response relationship between increasing intensity of cigarette/bidi consumption and increasing mortality. An elevated risk of death from ischemic heart disease (HR 1.87, 1.08 3.24) was associated with current cigarette/bidi smoking. Among women, the corresponding HRs were 1.65 (95% CI 1.16 2.36) for all-cause mortality and 2.69 (95% CI 1.20 6.01) for ischemic heart disease mortality. Similar associations were observed for hookah smoking. There was a trend towards reduced risk for the mortality outcomes with older age at onset of cigarette/bidi smoking and increasing years since quitting cigarette/bibi smoking among men. We estimated that cigarette/bidi smoking accounted for about 25.0% of deaths in men and 7.6% in women.
  
  
  CONCLUSIONS
  Tobacco smoking was responsible for substantial proportion of premature deaths in the Bangladeshi population, especially among men. Stringent measures of tobacco control and cessation are needed to reduce tobacco-related deaths in Bangladesh.
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, New York, United States of America.
authors.forename: Fen
authors.initials: F
authors.lastname: Wu
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.forename: Faruque
authors.initials: F
authors.lastname: Parvez
authors.forename: Stephanie
authors.initials: S
authors.lastname: Segers
authors.forename: Maria
authors.initials: M
authors.lastname: Argos
authors.forename: Tariqul
authors.initials: T
authors.lastname: Islam
authors.forename: Alauddin
authors.initials: A
authors.lastname: Ahmed
authors.forename: Muhammad
authors.initials: M
authors.lastname: Rakibuz-Zaman
authors.forename: Rabiul
authors.initials: R
authors.lastname: Hasan
authors.forename: Golam
authors.initials: G
authors.lastname: Sarwar
authors.forename: Habibul
authors.initials: H
authors.lastname: Ahsan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001459:Bangladesh / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D002423:Cause of Death; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology / Q000401:mortality; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology* / Q000401:mortality; D055815:Young Adult