Singapore: According to a study in PLOS Medicine, by Prof Wei Zheng, professor of Medicine and director of the Vanderbilt Epidemiology Center, and Mr John Potter, a member and scientific advisor of the Fred Hutchinson Cancer Research Center, Seattle, Washington, tobacco smoking has caused around two million deaths in the recent years and a rising toll has been predicted.

Of the total population, half of the male population in asia are smokers. The authors believe that this rise in smoking among Asians is due to aggressive product marketing by tobacco companies and a lack of education about health issues related to tobacco.

For this population-based research, investigators pooled data from large cohort studies conducted in Asia and included demographic and risk factor information collected in seven Asian regions from the early 1960s through the late 1990s (although most of the studies enrolled participants after the mid-1980s). The cohorts of 1,223,092 participants who were at least 45 years of age were in Bangladesh, India, mainland China, Japan, Republic of Korea, Singapore and Taiwan.

Among men who had ever smoked, there was an elevated risk of death from cardiovascular disease (CVD), cancer or respiratory diseases in all of the geographic regions in 2004. The risk of death due to any disease, however, varied considerably across populations, with the stronger association generally found in Japan, South Korea, Singapore and Taiwan compared to that observed in China and India.

The association with cancer risk was quite consistent across study populations. Men who had smoked were nearly twice as likely to die from cancer, especially lung cancer, but there was also an elevated risk of death from cancers of the head and neck, esophagus, stomach, colorectum, liver, pancreas and bladder - all diseases that have been linked to smoking in previous studies, according to the authors.

Men who had ever smoked tobacco were approximately 50 percent more likely to die from respiratory diseases than those who had not smoked.

While women in most Asian regions are far less likely to smoke than men, the study also found an increased risk of death from cancer, CVD and respiratory diseases among east Asian women. Approximately 16.7 percent of lung cancer deaths in East Asian women, at least 45 years old were attributable to tobacco smoking in 2004, while for men, this number approached 63.2 percent.

"Our study showed a clear dose-response relationship between the length of time someone smoked and the number of packs they smoked, known as pack-years, and the risk of death from all causes," said Mr Zheng. "Tobacco smoking has now reached epidemic proportions in Asia and it is likely, with the maturation of this epidemic, and the lack of effective tobacco control efforts, smokers will continue to face an increased risk of death from cancer and other diseases."

Mr Zhenming Fu, a former postdoctoral fellow, Mr Xiao Ou Shu, MD, PhD, MPH, and Mr Gong Yang, MD, MPH were also involved in the study, funded by World Health Organization(WHO) and a number of government agencies in several countries, including the US National Institutes of Health.