Health effects associated with chewing tobacco: a Burden of Proof study

Gabriela F. Gil, Jason A. Anderson, Aleksandr Aravkin, Kayleigh Bhangdia, Sinclair Carr, Xiaochen Dai, Luisa S. Flor, Simon I. Hay, Matthew J. Malloy, Susan A. McLaughlin, Erin C. Mullany, Christopher J. L. Murray, Erin M. O’Connell, Chukwuma Okereke, Reed J. D. Sorensen, Joanna Whisnant, Peng Zheng and Emmanuela Gakidou ()
Additional contact information
Gabriela F. Gil: University of Washington
Jason A. Anderson: University of Washington
Aleksandr Aravkin: University of Washington
Kayleigh Bhangdia: University of Washington
Sinclair Carr: University of Washington
Xiaochen Dai: University of Washington
Luisa S. Flor: University of Washington
Simon I. Hay: University of Washington
Matthew J. Malloy: University of Washington
Susan A. McLaughlin: University of Washington
Erin C. Mullany: University of Washington
Christopher J. L. Murray: University of Washington
Erin M. O’Connell: University of Washington
Chukwuma Okereke: University of Washington
Reed J. D. Sorensen: University of Washington
Joanna Whisnant: University of Washington
Peng Zheng: University of Washington
Emmanuela Gakidou: University of Washington

Nature Communications, 2024, vol. 15, issue 1, 1-17

Abstract: Abstract Chewing tobacco use poses serious health risks; yet it has not received as much attention as other tobacco-related products. This study synthesizes existing evidence regarding the health impacts of chewing tobacco while accounting for various sources of uncertainty. We conducted a systematic review and meta-analysis of chewing tobacco and seven health outcomes, drawing on 103 studies published from 1970 to 2023. We use a Burden of Proof meta-analysis to generate conservative risk estimates and find weak-to-moderate evidence that tobacco chewers have an increased risk of stroke, lip and oral cavity cancer, esophageal cancer, nasopharynx cancer, other pharynx cancer, and laryngeal cancer. We additionally find insufficient evidence of an association between chewing tobacco and ischemic heart disease. Our findings highlight a need for policy makers, researchers, and communities at risk to devote greater attention to chewing tobacco by both advancing tobacco control efforts and investing in strengthening the existing evidence base.

Date: 2024
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DOI: 10.1038/s41467-024-45074-9

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