O R I G I N A L R E S E A R C H Tobacco consumption in relation to causes of death in an urban population of north India Ram B Singh1 Surendra Singh2 Pronobesh Chattopadhya1 Kalpana Singh1 Vijender Singh2 Shallendra K Kulshrestha2 Rukam S Tomar1 Rajeev Kumar1 Garima Singh1 Viola Mechirova3 Daniel Pella3 1Halberg Hospital and Research Institute and 2Hindu College, Moradabad, India; 3Faculty of Medicine, Safaric University, Kosice, Slovakia Correspondence: Ram B Singh Halberg Hospital and Research Institute, Civil Lines, Moradabad-10(UP)244001, India Tel 0091 591 2417437 Fax 0091 591 2417437 Email icn2008@mickyonline.com icn2005@sancharnet.in Background: Noncommunicable diseases have become a public heath problem in India concomitant with economic development, leading to increases in tobacco consumption, obesity, and changes in diet and lifestyle. Although observation suggests that tobacco consumption is a major risk factor for deaths due to circulatory, pulmonary, and malignant diseases, such studies are not available from most populations in developing countries. Subjects and methods: For the period 1999–2001, we studied the randomly selected records of death of 2222 (1385 men and 837 women) decedents, aged 25–64 years, out of 3034 death records overall from the records at Municipal Corporation, Moradabad. All the families of these deceased could be contacted individually to ﬁnd out the causes of death, by scientist/doctor administered, informed consented, verbal autopsy questionnaire, completed with the help of the spouse and local treating doctor practicing in the appropriate healthcare region. Social classes and tobacco intakes were assessed by a questionnaire. Results: The prevalence of tobacco consumption, including chewing + smoking, were 45% (n = 623) among men and 15% (n = 125) among women decedents. However, smoking was observed in 20% and tobacco chewing in 30% of male decedents, while only 6% of female decedents smoked and 10% chewed tobacco. Social class had no impact on tobacco consumption in men but did inﬂuence one subgroup >55 years among women, ie, among those who had the highest tobacco consumption. Tobacco intakes were signiﬁcantly more common among dece- dents dying due to circulatory, malignant, and pulmonary diseases, compared with other causes (men 61.1%, 76.6%, pulmonary 77.3% vs 31%, P < 0.001; women 27.5%, 75.9%, pulmonary 24.6% vs 0.42%, P < 0.001) of mortality, respectively. Pulmonary causes included chronic bronchitis and asthma. Circulatory diseases (29.1%, n = 646) including heart attacks (10.0%), stroke (7.8%), valvular heart disease (7.2%, n = 160), sudden cardiac death and inﬂammatory cardiac disease, each (2.0%, n = 44) were the second most common causes of deaths, after infections (41.1%, n = 915). Malignant neoplasm (5.8%, n = 131), injury (14.0%, n = 313), and miscellaneous causes of deaths, including diabetes mellitus (2.2%, n = 49) were noted in 9.1%, (n = 202) of death records. Cancers of the lung (1.6%), oral cavity (1.5%), liver (1.1%), stomach (0.9%), breast (0.31%), uterus, cervix, and ovary (0.27%) were relatively common causes for deaths due to malignancy. Conclusions: This study shows that tobacco consumption appears to be a major contributor to deaths due to circulatory diseases and malignant diseases in India. Social class status had little impact on tobacco consumption in male decedents. Rapid changes in diet and lifestyle, increases in tobacco consumption, and possibly aging of the population, appear to be strongly associated with mortality due to cardiovascular diseases and cancer in this middle-income country. Keywords: tobacco chewing, mortality, cause of death, socioeconomic status, risk factors, urban deaths Introduction There is scanty evidence regarding the causes of deaths in developing countries, although hospital records indicate a rapid increase in mortality and morbidity from International Journal of COPD 2007:2(2) 177–185 © 2007 Dove Medical Press Limited. All rights reserved 177