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American Journal of Epidemiology Advance Access originally published online on November 6, 2007
American Journal of Epidemiology 2008 167(3):330-340; doi:10.1093/aje/kwm293
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American Journal of Epidemiology © The Author 2007. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Joint Effects of Tobacco Use and Body Mass on All-Cause Mortality in Mumbai, India: Results from a Population-based Cohort Study

Mangesh S. Pednekar1,2, Prakash C. Gupta1, James R. Hebert3 and Matti Hakama2

1 Healis-Sekhsaria Institute for Public Health, Belapur, India
2 Tampere School of Public Health, University of Tampere, Tampere, Finland
3 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC

Correspondence to Mangesh S. Pednekar, Healis-Sekhsaria Institute for Public Health, 601/B, Great Eastern Chambers, Plot No. 28, Sector 11, CBD Belapur, India (e-mail: pednekarmangesh{at}rediffmail.com, pcgupta{at}healis.org).

Received for publication June 11, 2007. Accepted for publication September 12, 2007.

The joint effects of tobacco use and body mass on mortality have not been well characterized, although evidence regarding the effect of smoking on the association between body mass and mortality is accumulating. To study the joint effects of these important risk factors, the authors conducted a prospective cohort study of 148,173 men and women aged ≥35 years in Mumbai, India. Subjects were recruited during 1991–1997 and then followed for approximately 5–6 years (1997–2003). During 774,129 person-years of follow-up, 13,261 deaths were observed. Tobacco use increased the risk of death across different categories of body mass, with particularly high risks being observed in extreme body mass categories. Among men, obese smokers and obese never users of tobacco were at 56% and 34% increased risks of death, respectively, compared with overweight never users of tobacco. Similarly, at highest risk were extremely thin males who smoked bidis (relative risk = 3.45) or cigarettes (relative risk = 3.32). Body mass and all forms of tobacco use had independent as well as multiplicative joint effects on mortality risk. Tobacco use and undernutrition are serious problems in India. The current study indicates that obesity may emerge as a serious public health problem with which tobacco use may interact.

body mass index; India; mortality; obesity; thinness; smoking; tobacco; tobacco, smokeless

Abbreviations: BMI, body mass index


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M. S. Pednekar, P. C. Gupta, J. R. Hebert, and M. Hakama
RE: "JOINT EFFECTS OF TOBACCO USE AND BODY MASS ON ALL-CAUSE MORTALTY IN MUMBAI, INDIA: RESULTS FROM A POPULATION-BASED COHORT STUDY"
Am. J. Epidemiol., September 12, 2008; (2008) kwn288v1.
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