Death attributed to tobacco smoking is likely to account for nearly one million deaths per year by 2010, with more than two thirds of these deaths likely to occur in people who are middle-aged, researchers warn in The New England Journal of Medicine.

The findings stem from the first nationally representative study of smoking in India as a whole. Professor Prabhat Jha from the University of Toronto and a multinational team estimated the smoking prevalence among 33,069 women and 41,054 men who were deceased, and in a similar number of male and female relatives of the deceased.

Mortality among both male and female smokers was around twice as great as that of non-smokers, both men and women, with smoking directly responsible for 20 percent of deaths in males and 5 percent of deaths in females between ages 30 and 69 years, the researchers report.

Death due to tuberculosis was three times greater among women smokers and more than twice as great among men smokers compared with non-smokers, they also found.

Silent tuberculosis infection is widespread in the Indian population and smoking may have facilitated progression to severe disease, they postulate.

Around one third of all deaths due to tuberculosis, lung disease and cancer, and one fifth of deaths due to heart disease were among smokers, the researchers point out.

Smoking ‘bidis’ (rolled tobacco) is likely to reduce the life span by 6 years in males and 8 years in females, while cigarette smoking in males could take away 10 years from their life, the researchers estimate. The difference is probably due to the lower tobacco content in bidis, they explain.

“The extreme risks from smoking that we found surprised us,” Professor Jha told Reuters Health. “Smoking kills differently than in the west, with tuberculosis being the main cause in rural areas and heart attacks in the urban areas,” he said.

“Very few give up smoking in India,” Professor Jha observed. “There are no safe levels, even a single cigarette or bidi per day increases the risk of mortality significantly,” he cautioned.

“I am alarmed by the results of this study,” said India’s federal health minister Dr. Abumani Ramadoss in a related press release. We plan to strengthen the tobacco control measures and educate the poor and illiterate about the risks of smoking, he adds.

“Smoking kills, but stopping works,” said Professor Sir Richard Peto, a study co-author from Oxford University.

SOURCE: The New England Journal of Medicine, February 13, 2008.