Association Between Betel Quid Consumption and Respiratory Disease Mortality in a Prospective Bangladeshi Cohort.
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BACKGROUND: Betel quid is a widely consumed substance that has been associated with higher mortality and increased risk of several diseases. RESEARCH QUESTION: Is betel quid use associated with increased respiratory disease mortality, particularly in COPD? STUDY DESIGN AND METHODS: A prospective cohort included 20,033 individuals 18 to 75 years of age living in Araihazar, Bangladesh. A total of 476 deaths resulting from respiratory disease were recorded during follow-up between October 2000 and April 2024. Data on baseline demographics, lifestyle factors, and betel nut use were ascertained using standardized questionnaires. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for associations between betel consumption practices and the risk of death due to respiratory disease while adjusting for age, BMI, educational attainment, sex, and cigarette smoking history. RESULTS: Cohort members who had ever consumed betel were at increased risk of death due to respiratory disease (HR, 1.38; 95% CI, 1.13-1.69), including COPD (HR, 1.56; 95% CI, 1.19- 2.05) but not lung cancer (HR, 1.24; 95% CI, 0.81-1.89). We observed a dose-response relationship between indicators of betel use intensity and COPD mortality; compared with those who never used betel, the HR was 1.46 (95% CI, 1.10-1.94) and 2.47 (95% CI, 1.64-3.74) for those who did use betel with low and high levels of consumption, respectively. The association did not differ appreciably by other characteristics and remained apparent in female individuals (HR, 3.63; 95% CI, 2.01-6.59) and people who have never smoked (HR, 3.44; 95% CI, 1.85-6.39). The population attributable fraction for betel use was 16.3% for deaths from COPD. INTERPRETATION: Betel quid consumption was associated with increased mortality from respiratory disease, including COPD, in this cohort. Efforts to bolster clinical and public awareness are warranted to help combat the global health emergency posed by betel quid consumption.