Smokeless Tobacco Use Linked to Increased Risk of Kidney Disease, Anemia

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New research is calling attention to the potential increase in risk for anemia, chronic kidney disease, and other diseases or disease risk factors associated with using smokeless tobacco.

An analysis of more than 850 adults from Bangladesh, results of the study suggest use of smokeless tobacco was associated with significantly greater odds of developing anemia, hypertension, and chronic kidney disease.

“Our study has provided initial evidence of an association between [smokeless tobacco] consumption and several risk factors for [chronic kidney disease], including older age, illiteracy, shorter sleep duration, undernutrition, hypertension, and anemia,” wrote investigators.¹ “Although further research is warranted to elucidate the underlying mechanisms and confirm these findings, our study serves as a valuable resource for policymakers seeking to improve public health in rural and peri-urban regions of developing nations.”

Few public health efforts have deemed as successful as the fight against tobacco use. However, while rates of tobacco use have declined markedly, the perception of smokeless tobacco products as being less harmful has contributed to their continued use in contemporary settings. According to recent reports, use of smokeless tobacco products is rising in many parts of the world and is the primary form of tobacco use in some regions. An overall lack of understanding surrounding the effects of smokeless tobacco products on patient health hinders education-based cessation efforts.²

As investigators note, because of an elevated rate of use among the general population, cohorts from Bangladesh offer a unique opportunity to examine the effects of smokeless tobacco use. Using random sampling and data from the Mirzapur Demographic Surveillance System of Bangladesh, investigators identified 872 adult patients for their study. Of these, 252 were smokeless tobacco users and 620 were not smokeless tobacco users.¹

All participants in the study completed a semi-structured questionnaire, physical examination, anthropometrics measurement, and blood and urine testing.¹

Results of the investigators’ univariate analysis revealed statistically significant associations between multiple factors and smokeless tobacco use, including being aged 46 years of age or older (Odds Ratio [OR], 7.10; 95% Confidence Interval [CI], 4.79-10.94), being female (OR, 1.64; 95% CI, 1.21–2.22). Other factors, such as being a widow (OR, 3.40; 95% CI, 2.24–5.17), lack of formal schooling (OR, 4.91; 95% CI; 3.59–6.72), and sleeping duration less than 7 hours per day (OR, 2.33; 95% CI, 1.70–3.19) were all associated with increased risk of smokeless tobacco use.¹

Further analysis revealed smokeless tobacco users were at a significantly greater risk of undernutrition (OR, 1.63; 95% CI, 1.15–2.33), hypertension (OR, 1.52; 95% CI, 1.13–2.05), anemia (OR, 1.94; 95% CI, 1.39–2.71) and chronic kidney disease (OR, 1.62; 95% CI, 1.15–2.27).¹

“A comprehensive analysis of the relationship between kidney ailments and [smokeless tobacco] usage has not been undertaken,” investigators wrote.¹ “Nonetheless, our analysis revealed a greater odds ratio of CKD among [smokeless tobacco] users. Several experimental studies have proposed a connection between kidney disorders and consumption. Further research in this area is warranted.”

References:

1. Sarker MHR, Moriyama M, Sujon H, et al. Smokeless tobacco consumption and its association with risk factors of chronic kidney disease in rural and peri-urban Bangladesh. Tob Induc Dis. 2023;21:138. Published 2023 Oct 20. doi:10.18332/tid/171358
2. Hajat C, Stein E, Ramstrom L, Shantikumar S, Polosa R. The health impact of smokeless tobacco products: a systematic review. Harm Reduct J. 2021;18(1):123. Published 2021 Dec 4. doi:10.1186/s12954-021-00557-6