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Spatial, Temporal, and Demographic Patterns in Prevalence of Chewing Tobacco Use in 204 Countries and Territories, 1990-2019: A Systematic Analysis From the Global Burden of Disease Study 2019 Publisher Pubmed



Kendrick PJ1 ; Reitsma MB1 ; Abbasikangevari M3 ; Abdoli A5 ; Abdollahi M6, 7 ; Abedi A14 ; Abhilash ES16 ; Aboyans V17, 18 ; Adebayo OM19 ; Advani SM21, 22 ; Ahinkorah BO23 ; Ahmad S25 ; Ahmadi K26 ; Ahmed H27 Show All Authors
Authors
  1. Kendrick PJ1
  2. Reitsma MB1
  3. Abbasikangevari M3
  4. Abdoli A5
  5. Abdollahi M6, 7
  6. Abedi A14
  7. Abhilash ES16
  8. Aboyans V17, 18
  9. Adebayo OM19
  10. Advani SM21, 22
  11. Ahinkorah BO23
  12. Ahmad S25
  13. Ahmadi K26
  14. Ahmed H27
  15. Aji B28
  16. Akalu Y29
  17. Akunna CJ36, 37
  18. Alahdab F38
  19. Alaly Z39, 40
  20. Alanezi FM44
  21. Alanzi TM41
  22. Alhabib KF45
  23. Ali T47
  24. Alif SM48
  25. Alipour V50, 51
  26. Aljunid SM56, 57
  27. Alomari MA58, 59
  28. Amin TT61
  29. Amini S62
  30. Amu H65
  31. Ancuceanu R66
  32. Anderson JA1
  33. Andrei CL67
  34. Andrei T71
  35. Ansarimoghaddam A72
  36. Antony B73
  37. Anvari D74, 76
  38. Arabloo J50
  39. Arian ND1
  40. Arora M77, 80
  41. Artanti KD81
  42. Asmare WN84
  43. Atnafu DD86
  44. Ausloos M71, 89
  45. Awan AT90, 91
  46. Ayano G92
  47. Aynalem GL30
  48. Azari S50
  49. Badiye AD95
  50. Baig AA96
  51. Banach M99, 100
  52. Banerjee SK101
  53. Barkercollo SL102
  54. Barnighausen TW103, 105
  55. Barqawi HJ109
  56. Basu S106, 111
  57. Bayati M115
  58. Bazarganhejazi S118, 119
  59. Bekuma TT120
  60. Bennett DA121
  61. Bensenor IM122
  62. Benzian H124
  63. Benziger CP125
  64. Berman AE126
  65. Bhagavathula AS127, 128
  66. Bhala N129, 130
  67. Bhardwaj N131
  68. Bhardwaj P132, 133
  69. Bhattacharyya K136, 137
  70. Bibi S138
  71. Bijani A139
  72. Biondi A141
  73. Braithwaite D142, 144
  74. Brenner H145
  75. Brunoni AR122, 123
  76. Burkart K1, 2
  77. Nagaraja SB146
  78. Butt ZA147, 148
  79. Dos Santos FLC149
  80. Car J112, 150
  81. Carreras G152
  82. Castaldellimaia JM123
  83. Cattaruzza MSS153
  84. Chang JC154, 155
  85. Chaturvedi P156, 157
  86. Chen S103
  87. Chidoamajuoyi OG158
  88. Chu DT159
  89. Chung SC160, 163
  90. Ciobanu LG164, 166
  91. Costa VM167
  92. Couto RAS168
  93. Dagnew B31
  94. Dai X1
  95. Damasceno AAM170
  96. Damiani G171, 172
  97. Dandona L1, 79
  98. Dandona R1, 2, 79, 175
  99. Daneshpajouhnejad P176, 177
  100. Gela JD179
  101. Molla MD32
  102. Desta AA33
  103. Dharmaratne SD1, 2, 180
  104. Dhimal M181
  105. Eagan AW107, 183
  106. Kalan ME184
  107. Edvardsson K185
  108. Effiong A187
  109. El Tantawi M189
  110. Elbarazi I128
  111. Esmaeilnejad S190, 191
  112. Fadhil I192
  113. Faraon EJA193
  114. Farwati M194, 196
  115. Farzadfar F8
  116. Fazlzadeh M9, 197
  117. Feigin VL1, 198, 199
  118. Feldman R1
  119. Filip I200, 201
  120. Filippidis F111
  121. Fischer F202
  122. Flor LS203, 204
  123. Foigt NA205
  124. Folayan MO206
  125. Foroutan M207
  126. Gad MM195, 208
  127. Gallus S210
  128. Geberemariyam BS211
  129. Gebregiorgis BG212
  130. Getacher L213
  131. Obsa AG214
  132. Ghafourifard M215
  133. Gheshlagh RG218
  134. Ghashghaee A50, 52
  135. Ghith N220
  136. Gil GF1
  137. Gill PS221
  138. Ginawi IA223
  139. Goharinezhad S53
  140. Golechha M224
  141. Gopalani SV225, 226
  142. Gorini G151
  143. Grivna M128, 227
  144. Guha A173, 228
  145. Guimaraes RA229
  146. Guo Y48, 230
  147. Gupta RD231, 233
  148. Gupta R234, 235
  149. Gupta T236
  150. Gupta V1, 2
  151. Hafezinejad N10, 237
  152. Haider MR239
  153. Hamadeh RR240
  154. Hankey GJ241, 242
  155. Hargono A81
  156. Hay SI1, 2
  157. Heidari G243
  158. Herteliu C71, 244
  159. Hezam K245, 246
  160. Hird TR247
  161. Holla R93
  162. Hosseinzadeh M50
  163. Hostiuc M68
  164. Hostiuc S69, 248
  165. Househ M249
  166. Hsiao T1
  167. Huang J250
  168. Ibeneme CU251, 252
  169. Ibitoye SE253
  170. Ilic IM255
  171. Ilic MD257
  172. Inbaraj LR259
  173. Irvani SSN260
  174. Islam JY209
  175. Islam RM48
  176. Islam SMS261, 262
  177. Islami F264
  178. Iso H265
  179. Itumalla R267
  180. Jaafari J268
  181. Jain V194
  182. Jakovljevic M258, 269
  183. Jang SI270
  184. Jayaram S273
  185. Jeemon P274
  186. Jha RP275, 276
  187. Jonas JB104, 277
  188. Jurisson M278
  189. Kabir A54
  190. Kabir Z279
  191. Kalankesh LR216
  192. Kanchan T134
  193. Kandel H263, 280
  194. Kapoor N95
  195. Karch A281
  196. Karimi SE217
  197. Kebede KM85
  198. Kelkay B34
  199. Kennedy RD282
  200. Khader YS60
  201. Khan EA283
  202. Khayamzadeh M4, 284
  203. Kim GR270
  204. Kimokoti RW285
  205. Kivimaki M161, 286
  206. Kosen S287
  207. Laxminarayana SLK288
  208. Koyanagi A289, 290
  209. Krishan K291
  210. Kugbey N292
  211. Kumar GA79
  212. Kumar N293
  213. Kurmi OP294, 295
  214. Kusuma D113, 297
  215. Lacey B121, 298
  216. Landires I299, 302
  217. Lasrado S303
  218. Lauriola P304
  219. Lee DW271, 272
  220. Lee YH305
  221. Leung J306
  222. Li S49
  223. Lin H307
  224. Liu W308
  225. Lugo A210
  226. Kunjathur SM309
  227. Majeed A112
  228. Maleki A9, 219
  229. Malekzadeh R11, 116
  230. Malta DC310
  231. Mamun AA312
  232. Manjunatha N313
  233. Mansouri B314
  234. Mansournia MA12
  235. Martini S82, 319
  236. Mathur MR78, 320
  237. Mathur P83
  238. Mazidi M321
  239. Mckee M324
  240. Medinasolis CE326
  241. Mehata S327
  242. Mendoza W328
  243. Menezes RG42
  244. Miazgowski B330
  245. Michalek IM331
  246. Miller TR92, 332
  247. Mini GK333, 334
  248. Mirica A71
  249. Mirrakhimov EM335, 336
  250. Mirzaei H337
  251. Misra S135
  252. Mohammad Y46
  253. Mohammadianhafshejani A338
  254. Mohammed S103, 339
  255. Mokdad AH1, 2
  256. Molokhia M322
  257. Monasta L341
  258. Moni MA342
  259. Moradzadeh R63
  260. Morrison SD343
  261. Mossie TB87
  262. Mubarik S344
  263. Mullany EC1
  264. Murray CJL1, 2
  265. Nagaraju SP94
  266. Naghavi M1, 2
  267. Naik N346
  268. Nalini M11, 315
  269. Nangia V347
  270. Naqvi AA43, 348
  271. Swamy SN349
  272. Naveed M350
  273. Nazari J64
  274. Nduaguba SO143
  275. Negoi RI70, 351
  276. Kandel SN352
  277. Nguyen HLT353
  278. Nigatu YT354, 355
  279. Nixon MR1
  280. Nnaji CA357, 358
  281. Noubiap JJ165
  282. Nowak C359
  283. Nunezsamudio V300, 301
  284. Ogbo FA360
  285. Oguntade AS20, 162
  286. Oh IH362
  287. Olagunju AT296, 363
  288. Owolabi MO20, 254
  289. Pakshir K117
  290. Pan L365
  291. Pana A71, 366
  292. Panagiotakos D367
  293. Pandajonas S104
  294. Pandey A182, 368
  295. Parekh U369
  296. Park EC270, 271
  297. Park EK370
  298. Kan FP55
  299. Pathak M371
  300. Pawar S372
  301. Pestell RG374, 375
  302. Pham HQ353
  303. Pinheiro M169
  304. Pokhrel KN376
  305. Pourshams A11
  306. Prashant A377
  307. Radfar A378
  308. Rahimimovaghar V13
  309. Ur Rahman MH186
  310. Rahman MA379, 380
  311. Rahmani AM381, 382
  312. Ram P383
  313. Rana J384, 385
  314. Ranabhat CL386, 387
  315. Rathi P93
  316. Rawaf DL112, 388
  317. Rawaf S114, 389
  318. Rawassizadeh R390
  319. Renzaho AMN360, 361
  320. Rezapour A50
  321. Riaz MA97
  322. Roever L391
  323. Ronfani L341
  324. Roshandel G392
  325. Roy A346
  326. Roy B393
  327. Saddik B110
  328. Sahebkar A394, 395
  329. Salehi S15
  330. Salimzadeh H11
  331. Samy AM396
  332. Sanabria J174, 397
  333. Santricmilicevic MM255, 256
  334. Sao Jose BP311
  335. Sathian B398, 399
  336. Sawhney M400
  337. Saya GK401
  338. Schwendicke F402
  339. Seidu AA403, 404
  340. Kumar NS405
  341. Sepanlou SG11, 116
  342. Shafaat O178, 237
  343. Shah SM128, 406
  344. Shaikh MA407
  345. Shannawaz M408
  346. Sharafi K316
  347. Sheikh A108, 409
  348. Sheikhbahaei S237
  349. Shigematsu M410
  350. Shiri R411
  351. Shishani K412
  352. Shivakumar KM413
  353. Shivalli S325
  354. Shrestha R373
  355. Siabani S24, 317
  356. Sidemo NB414
  357. Sigfusdottir ID416, 417
  358. Sigurvinsdottir R416
  359. Silva JP167
  360. Singh A73
  361. Singh JA418, 419
  362. Singh V421
  363. Sinha DN422, 423
  364. Skryabin VY424
  365. Skryabina AA426
  366. Soroush A318
  367. Soyiri IN427
  368. Sreeramareddy CT428
  369. Stein DJ356
  370. Steiropoulos P429
  371. Stortecky S430
  372. Straif K431, 432
  373. Abdulkader RS433, 434
  374. Sulo G435
  375. Sundstrom J436, 437
  376. Tabuchi T438
  377. Tadesse EG415
  378. Tamiru AT34
  379. Tareke M87
  380. Tareque MI439
  381. Tarigan IU440
  382. Thakur B441
  383. Thankappan KR442
  384. Thapar R293
  385. Tolani MA340
  386. Tovanipalone MR443, 444
  387. Tran BX445
  388. Tripathy JP446
  389. Tsegaye GW88
  390. Tymeson HD1
  391. Ullah S138
  392. Unim B447
  393. Updike RL1
  394. Uthman OA222
  395. Vacante M141
  396. Vardavas C448
  397. Venketasubramanian N449, 450
  398. Verma M451
  399. Vidale S452, 453
  400. Vo B454
  401. Vu GT456
  402. Waheed Y457
  403. Wang Y323
  404. Welding K238
  405. Werdecker A458
  406. Whisnant JL1
  407. Wickramasinghe ND459
  408. Wubishet BL188, 460
  409. Yamagishi K266, 461
  410. Yano Y462
  411. Yazdifeyzabadi V463, 464
  412. Yeshaw Y35
  413. Yimmer MZ465
  414. Yonemoto N466, 467
  415. Yousefi Z75
  416. Yu C344
  417. Yunusa I105, 232
  418. Yusefzadeh H468
  419. Zaman MS469
  420. Zamani M140
  421. Zamanian M63
  422. Zastrozhin MS425, 470
  423. Zastrozhina A455
  424. Zhang J364, 420
  425. Zhang ZJ345
  426. Zhong C250
  427. Zuniga YMH98, 329
  428. Gakidou E1, 2
Show Affiliations
Authors Affiliations
  1. 1. Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
  2. 2. Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
  3. 3. Social Determinants of Health Research Center, Tehran, Iran
  4. 4. Shahid Beheshti University of Medical Sciences, Tehran, Iran
  5. 5. Department of Parasitology and Mycology, Jahrom University of Medical Sciences, Jahrom, Iran
  6. 6. The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
  7. 7. School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
  8. 8. Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
  9. 9. Department of Environmental Health Engineering, Tehran University of Medical Sciences, Tehran, Iran
  10. 10. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  11. 11. Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  12. 12. Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
  13. 13. Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
  14. 14. Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, United States
  15. 15. Department of Radiology, University of Southern California, Los Angeles, CA, United States
  16. 16. Department of Botany, Sree Narayana Guru College Chelannur, Kozhikode, India
  17. 17. Department of Cardiology, Dupuytren University Hospital, Limoges, France
  18. 18. University of Limoges, Limoges, France
  19. 19. College of Medicine, University College Hospital, Ibadan, Ibadan, Nigeria
  20. 20. Department of Medicine, University College Hospital, Ibadan, Ibadan, Nigeria
  21. 21. Social Behavioral Research Branch, National Institute of Health, Bethesda, MD, United States
  22. 22. Department of Oncology, Georgetown University, Washington, DC, United States
  23. 23. The Australian Centre for Public and Population Health Research (ACPPHR), University of Technology Sydney, Sydney, NSW, Australia
  24. 24. School of Health, University of Technology Sydney, Sydney, NSW, Australia
  25. 25. Faculty of Pharmacy, MAHSA University, Kuala Langat, Malaysia
  26. 26. Lincoln Medical School, Universities of Nottingham and Lincoln, Lincoln, United Kingdom
  27. 27. Department of Biosciences, COMSATS Institute of Information Technology, Islamabad, Pakistan
  28. 28. Faculty of Medicine and Public Health, Jenderal Soedirman University, Purwokerto, Indonesia
  29. 29. Department of Medical Physiology, University of Gondar, Gondar, Ethiopia
  30. 30. Department of Clinical Midwifery, University of Gondar, Gondar, Ethiopia
  31. 31. Department of Human Physiology, University of Gondar, Gondar, Ethiopia
  32. 32. Department of Biochemistry, University of Gondar, Gondar, Ethiopia
  33. 33. Department of Surgical Nursing, University of Gondar, Gondar, Ethiopia
  34. 34. Department of Midwifery, University of Gondar, Gondar, Ethiopia
  35. 35. Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
  36. 36. Department of Public Health, The Intercountry Centre for Oral Health (ICOH) for Africa, Jos, Nigeria
  37. 37. Department of Public Health, Federal Ministry of Health, Garki, Nigeria
  38. 38. Mayo Evidence-based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, MN, United States
  39. 39. John T Milliken Department of Internal Medicine, Washington University in St Louis, St Louis, MO, United States
  40. 40. Clinical Epidemiology Center, Department of Veterans Affairs, St Louis, MO, United States
  41. 41. Health Information Management and Technology Department, Dammam, Saudi Arabia
  42. 42. Forensic Medicine Division, Dammam, Saudi Arabia
  43. 43. Pharmacy Practice Department, Dammam, Saudi Arabia
  44. 44. Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
  45. 45. Department of Cardiac Sciences, King Saud University, Riyadh, Saudi Arabia
  46. 46. Department of Internal Medicine, King Saud University, Riyadh, Saudi Arabia
  47. 47. Department of Psychiatry, Haramaya University, Harar, Ethiopia
  48. 48. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
  49. 49. School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
  50. 50. Health Management and Economics Research Center
  51. 51. Department of Health Economics
  52. 52. Student Research Committee
  53. 53. Preventive Medicine and Public Health Research Center
  54. 54. Minimally Invasive Surgery Research Center
  55. 55. Iran University of Medical Sciences, Tehran, Iran
  56. 56. Department of Health Policy and Management, Kuwait University, Safat, Kuwait
  57. 57. International Centre for Casemix and Clinical Coding, National University of Malaysia, Bandar Tun Razak, Malaysia
  58. 58. Department of Physical Education, Qatar University, Doha, Qatar
  59. 59. Department of Rehabilitation Sciences and Physical Therapy, Jordan University of Science and Technology, Irbid, Jordan
  60. 60. Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan
  61. 61. Public Health Department, Cairo University, Cairo, Egypt
  62. 62. Department of Health Services Management, Arak University of Medical Sciences, Arak, Iran
  63. 63. Department of Epidemiology, Arak University of Medical Sciences, Arak, Iran
  64. 64. Department of Pediatrics, Arak University of Medical Sciences, Arak, Iran
  65. 65. Department of Population and Behavioural Sciences, University of Health and Allied Sciences, Ho, Ghana
  66. 66. Pharmacy Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  67. 67. Cardiology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  68. 68. Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  69. 69. Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  70. 70. Department of Anatomy and Embryology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  71. 71. Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania
  72. 72. Department of Epidemiology and Biostatistics, Zahedan University of Medical Sciences, Zahedan, Iran
  73. 73. Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
  74. 74. Department of Parasitology, Mazandaran University of Medical Sciences, Sari, Iran
  75. 75. Department of Environmental Health, Mazandaran University of Medical Sciences, Sari, Iran
  76. 76. Department of Parasitology, Iranshahr University of Medical Sciences, Iranshahr, Iran
  77. 77. Health Promotion Division, Gurugram, India
  78. 78. Health Policy Research, Gurugram, India
  79. 79. Public Health Foundation of India, Gurugram, India
  80. 80. Research Department, Health Related Information Dissemination Amongst Youth, New Delhi, India
  81. 81. Department of Epidemiology, Surabaya, Indonesia
  82. 82. Faculty of Public Health, Universitas Airlangga, Airlangga University, Surabaya, Indonesia
  83. 83. National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bengaluru, India
  84. 84. Department of Nursing, Mizan-Tepi University, Mizan Teferi, Ethiopia
  85. 85. Department of Public Health, Mizan-Tepi University, Mizan Teferi, Ethiopia
  86. 86. Department of Health System and Health Economics, Bahir Dar University, Bahir Dar, Ethiopia
  87. 87. Department of Psychiatry, Bahir Dar University, Bahir Dar, Ethiopia
  88. 88. College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
  89. 89. School of Business, University of Leicester, Leicester, United Kingdom
  90. 90. School of Nursing and Health Sciences, Capella University, Minneapolis, MN, United States
  91. 91. Grant Writing Academy, University of Nevada, Las Vegas, NV, United States
  92. 92. School of Public Health, Curtin University, Perth, WA, Australia
  93. 93. Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
  94. 94. Department of Nephrology, Manipal Academy of Higher Education, Manipal, India
  95. 95. Department of Forensic Science, Government Institute of Forensic Science, Nagpur, India
  96. 96. Unit of Biochemistry, Kuala Terengganu, Malaysia
  97. 97. Faculty of Business and Management, Universiti Sultan Zainal Abidin, Sultan Zainal Abidin University, Kuala Terengganu, Malaysia
  98. 98. #MentalHealthPH, Quezon City, Philippines
  99. 99. Department of Hypertension, Medical University of Lodz, Lodz, Poland
  100. 100. Polish Mothers' Memorial Hospital Research Institute, Lodz, Poland
  101. 101. School of Health Sciences, Walden University, Minneapolis, MN, United States
  102. 102. School of Psychology, University of Auckland, Auckland, New Zealand
  103. 103. Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
  104. 104. Department of Ophthalmology, Heidelberg University, Heidelberg, Germany
  105. 105. Harvard T H Chan School of Public Health, Harvard University, Boston, MA, United States
  106. 106. Center for Primary Care, Harvard University, Boston, MA, United States
  107. 107. Department of Global Health and Social Medicine, Harvard University, Boston, MA, United States
  108. 108. Division of General Internal Medicine, Harvard University, Boston, MA, United States
  109. 109. Department of Clinical Sciences, University of Sharjah, Sharjah, United Arab Emirates
  110. 110. Department of Family and Community Medicine, University of Sharjah, Sharjah, United Arab Emirates
  111. 111. School of Public Health, Imperial College London, London, United Kingdom
  112. 112. Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
  113. 113. Imperial College Business School, Imperial College London, London, United Kingdom
  114. 114. WHO Collaborating Centre for Public Health Education and Training, Imperial College London, London, United Kingdom
  115. 115. Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  116. 116. Non-communicable Disease Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  117. 117. Department of Parasitology and Mycology, Shiraz University of Medical Sciences, Shiraz, Iran
  118. 118. Department of Psychiatry, Charles R Drew University of Medicine and Science, Los Angeles, CA, United States
  119. 119. Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
  120. 120. Department of Public Health, Wollega University, Nekemte, Ethiopia
  121. 121. Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
  122. 122. Department of Internal Medicine, University of Sao Paulo, Sao Paulo, Brazil
  123. 123. Department of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
  124. 124. Department of Epidemiology and Health Promotion, New York University, New York, NY, United States
  125. 125. Heart and Vascular Center, Essentia Health, Duluth, MN, United States
  126. 126. Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, United States
  127. 127. Department of Social and Clinical Pharmacy, Charles University, Hradec Kralova, Czech Republic
  128. 128. Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
  129. 129. Institute of Applied Health Research and Translational Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
  130. 130. Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
  131. 131. Department of Anatomy, Government Medical College Pali, Pali, India
  132. 132. Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
  133. 133. School of Public Health, All India Institute of Medical Sciences, Jodhpur, India
  134. 134. Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, India
  135. 135. Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, India
  136. 136. Department of Statistical and Computational Genomics, National Institute of Biomedical Genomics, Kalyani, India
  137. 137. Department of Statistics, University of Calcutta, Kolkata, India
  138. 138. Institute of Soil and Environmental Sciences, University of Agriculture, Faisalabad, Faisalabad, Pakistan
  139. 139. Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
  140. 140. Student Research Committee, Babol University of Medical Sciences, Babol, Iran
  141. 141. Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
  142. 142. Department of Epidemiology, University of Florida, Gainesville, FL, United States
  143. 143. Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, FL, United States
  144. 144. Cancer Population Sciences Program, University of Florida Health Cancer Center, Gainesville, FL, United States
  145. 145. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
  146. 146. Department of Community Medicine, Employee State Insurance Post Graduate Institute of Medical Sciences and Research, Bangalore, India
  147. 147. School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
  148. 148. Al Shifa School of Public Health, Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan
  149. 149. Institute of Microengineering, Federal Polytechnic School of Lausanne, Lausanne, Switzerland
  150. 150. Centre for Population Health Sciences, Nanyang Technological University, Singapore, Singapore
  151. 151. Oncological Network, Prevention and Research Institute, Florence, Italy
  152. 152. Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
  153. 153. Department of Public Health and Infectious Diseases, La Sapienza University, Rome, Italy
  154. 154. College of Medicine, National Taiwan University, Taipei, Taiwan
  155. 155. Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
  156. 156. Center for Cancer Epidemiology, Tata Memorial Hospital, Mumbai, India
  157. 157. Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India
  158. 158. Department of Epidemiology, MD Anderson Cancer Center, Houston, TX, United States
  159. 159. Center for Biomedicine and Community Health, VNU-International School, Hanoi, Viet Nam
  160. 160. Department of Health Informatics, University College London, London, United Kingdom
  161. 161. Department of Epidemiology and Public Health, University College London, London, United Kingdom
  162. 162. Institute of Cardiovascular Science, University College London, London, United Kingdom
  163. 163. Health Data Research UK, London, United Kingdom
  164. 164. Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
  165. 165. Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia
  166. 166. School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
  167. 167. Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
  168. 168. Department of Chemical Sciences, University of Porto, Porto, Portugal
  169. 169. Department of Chemistry, University of Porto, Porto, Portugal
  170. 170. Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
  171. 171. IRCCS Istituto Ortopedico Galeazzi (Galeazzi Orthopedic Institute IRCCS), University of Milan, Milan, Italy
  172. 172. Department of Dermatology, Case Western Reserve University, Cleveland, OH, United States
  173. 173. Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH, United States
  174. 174. Department of Nutrition and Preventive Medicine, Case Western Reserve University, Cleveland, OH, United States
  175. 175. Indian Council of Medical Research, New Delhi, India
  176. 176. Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
  177. 177. Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran
  178. 178. Department of Radiology and Interventional Neuroradiology, Isfahan University of Medical Sciences, Isfahan, Iran
  179. 179. Department of Public Health, Ambo University, Ambo, Ethiopia
  180. 180. Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka
  181. 181. Health Research Section, Nepal Health Research Council, Kathmandu, Nepal
  182. 182. Research Department, Nepal Health Research Council, Kathmandu, Nepal
  183. 183. Department of Social Services, Tufts Medical Center, Boston, MA, United States
  184. 184. Department of Epidemiology, Florida International University, Miami, FL, United States
  185. 185. College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
  186. 186. School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
  187. 187. Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, NSW, Australia
  188. 188. Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia
  189. 189. Pediatric Dentistry and Dental Public Health Department, Alexandria University, Alexandria, Egypt
  190. 190. Department of Physiology, Tarbiat Modares University, Tehran, Iran
  191. 191. Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
  192. 192. Division of Non-Communicable Diseases, Ministry of Public Health and Population, Dubai, United Arab Emirates
  193. 193. Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines
  194. 194. Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States
  195. 195. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
  196. 196. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
  197. 197. Department of Environmental Health Engineering, Ardabil University of Medical Science, Ardabil, Iran
  198. 198. National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
  199. 199. Research Center of Neurology, Moscow, Russian Federation
  200. 200. Psychiatry Department, Kaiser Permanente, Fontana, CA, United States
  201. 201. School of Health Sciences, AT Still University, Mesa, AZ, United States
  202. 202. Institute of Gerontological Health Services and Nursing Research, Ravensburg-Weingarten University of Applied Sciences, Weingarten, Germany
  203. 203. Sergio Arouca National School of Public Health, Rio de Janeiro, Brazil
  204. 204. Federal University of Espirito Santo, Vitoria, Brazil
  205. 205. Institute of Gerontology, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
  206. 206. Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
  207. 207. Department of Medical Parasitology, Abadan Faculty of Medical Sciences, Abadan, Iran
  208. 208. Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
  209. 209. Department of Epidemiology, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
  210. 210. Department of Environmental Health Sciences, Mario Negri Institute for Pharmacological Research, Milan, Italy
  211. 211. Department of Public Health, Madda Walabu University, Bale Robe, Ethiopia
  212. 212. Department of Nursing, Debre Berhan University, Debre Berhan, Ethiopia
  213. 213. Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia
  214. 214. School of Psychology, Addis Ababa University, Addis Ababa, Ethiopia
  215. 215. Department of Medical Surgical Nursing, Tabriz University of Medical Sciences, Tabriz, Iran
  216. 216. School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
  217. 217. Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  218. 218. Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran
  219. 219. Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
  220. 220. Research Group for Genomic Epidemiology, Technical University of Denmark, Copenhagen, Denmark
  221. 221. Medical School, University of Warwick, Coventry, United Kingdom
  222. 222. Division of Health Sciences, University of Warwick, Coventry, United Kingdom
  223. 223. Family Medicine Research Center, Ministry of Health, Hail, Saudi Arabia
  224. 224. Health Systems and Policy Research, Indian Institute of Public Health Gandhinagar, Gandhinagar, India
  225. 225. Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
  226. 226. Department of Health and Social Affairs, Government of the Federated States of Micronesia, Palikir, Federated States of Micronesia
  227. 227. Department of Public Health and Preventive Medicine, Charles University, Prague, Czech Republic
  228. 228. Division of Cardiovascular Medicine, Ohio State University, Columbus, OH, United States
  229. 229. Institute of Tropical Pathology and Public Health (IPTSP), Federal University of Goias, Goiania, Brazil
  230. 230. Department of Epidemiology, Binzhou Medical University, Yantai City, China
  231. 231. Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, United States
  232. 232. Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, SC, United States
  233. 233. Centre for Noncommunicable Diseases and Nutrition, BRAC University, Dhaka, Bangladesh
  234. 234. Department of Preventive Cardiology, Eternal Heart Care Centre and Research Institute, Jaipur, India
  235. 235. Department of Medicine, Mahatma Gandhi University Medical Sciences, Jaipur, India
  236. 236. Department of Civil Engineering, Indian Institute of Technology Kanpur, Kanpur, India
  237. 237. Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, United States
  238. 238. Institute for Global Tobacco Control, Johns Hopkins University, Baltimore, MD, United States
  239. 239. Department of Social and Public Health, Ohio University, Athens, OH, United States
  240. 240. Department of Family and Community Medicine, Arabian Gulf University, Manama, Bahrain
  241. 241. Medical School, University of Western Australia, Perth, WA, Australia
  242. 242. Department of Neurology, Sir Charles Gairdner Hospital, Perth, WA, Australia
  243. 243. Santa Clara, CA, United States
  244. 244. School of Business, London South Bank University, London, United Kingdom
  245. 245. Department of Applied Microbiology, Taiz University, Taiz, Yemen
  246. 246. Department of Microbiology, Nankai University, Tianjin, China
  247. 247. Department for Health, University of Bath, Bath, United Kingdom
  248. 248. Clinical Legal Medicine Department, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
  249. 249. College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
  250. 250. Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
  251. 251. Department of Public Health and Disease Control, Ministry of Health, Umuahia, Nigeria
  252. 252. Nigerian Field Epidemiology and Laboratory Training Program, African Field Epidemiology Network, Abuja, Nigeria
  253. 253. Department of Health Promotion and Education, University of Ibadan, Ibadan, Nigeria
  254. 254. Department of Medicine, University of Ibadan, Ibadan, Nigeria
  255. 255. Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  256. 256. School of Public Health and Health Management, University of Belgrade, Belgrade, Serbia
  257. 257. Department of Epidemiology, University of Kragujevac, Kragujevac, Serbia
  258. 258. Department of Global Health, Economics and Policy, University of Kragujevac, Kragujevac, Serbia
  259. 259. Division of Community Health and Family Medicine, Bangalore Baptist Hospital, Bangalore, India
  260. 260. Tabriz, Iran
  261. 261. Institute for Physical Activity and Nutrition, Deakin University, Burwood, VIC, Australia
  262. 262. Sydney Medical School, University of Sydney, Sydney, NSW, Australia
  263. 263. Save Sight Institute, University of Sydney, Sydney, NSW, Australia
  264. 264. Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States
  265. 265. Public Health Department of Social Medicine, Osaka University, Suita, Japan
  266. 266. Graduate School of Medicine, Osaka University, Suita, Japan
  267. 267. Department of Health Management, University of Hail, Hail, Saudi Arabia
  268. 268. Department of Environmental Health Engineering, Guilan University of Medical Sciences, Rasht, Iran
  269. 269. Institute of Comparative Economic Studies, Hosei University, Tokyo, Japan
  270. 270. Department of Preventive Medicine, Yonsei University, Seoul, South Korea
  271. 271. Institute of Health Services Research, Yonsei University, Seoul, South Korea
  272. 272. Department of Public Health, Yonsei University, Seoul, South Korea
  273. 273. Department of Biochemistry, Government Medical College, Mysuru, India
  274. 274. Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
  275. 275. Department of Community Medicine, Dr Baba Saheb Ambedkar Medical College and Hospital, Delhi, India
  276. 276. Department of Community Medicine, Banaras Hindu University, Varanasi, India
  277. 277. Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing, China
  278. 278. Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
  279. 279. School of Public Health, University College Cork, Cork, Ireland
  280. 280. Sydney Eye Hospital, South Eastern Sydney Local Health District, Sydney, NSW, Australia
  281. 281. Institute for Epidemiology and Social Medicine, University of Munster, Munster, Germany
  282. 282. Institute for Global Tobacco Control, Baltimore, MD, United States
  283. 283. Department of Epidemiology and Biostatistics, Health Services Academy, Islamabad, Pakistan
  284. 284. The Iranian Academy of Medical Sciences, Tehran, Iran
  285. 285. Department of Nutrition, Simmons University, Boston, MA, United States
  286. 286. Department of Public Health, University of Helsinki, Helsinki, Finland
  287. 287. Jakarta, Indonesia
  288. 288. Kasturba Medical College, Udupi, India
  289. 289. Biomedical Research Networking Center for Mental Health Network (CIBERSAM), San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain
  290. 290. Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
  291. 291. Department of Anthropology, Panjab University, Chandigarh, India
  292. 292. University of Environment and Sustainable Development, Somanya, Ghana
  293. 293. Department of Community Medicine, Manipal Academy of Higher Education, Mangalore, India
  294. 294. Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
  295. 295. Department of Medicine, McMaster University, Hamilton, ON, Canada
  296. 296. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
  297. 297. Faculty of Public Health, University of Indonesia, Depok, Indonesia
  298. 298. National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, United Kingdom
  299. 299. Unit of Genetics and Public Health, Institute of Medical Sciences, Las Tablas, Panama
  300. 300. Unit of Microbiology and Public Health, Institute of Medical Sciences, Las Tablas, Panama
  301. 301. Department of Public Health
  302. 302. Ministry of Health, Herrera, Panama
  303. 303. Department of Otorhinolaryngology, Father Muller Medical College, Mangalore, India
  304. 304. Institute of Clinical Physiology, National Research Council, Pisa, Italy
  305. 305. Graduate School of Public Health, Ajou University, Suwon-si, South Korea
  306. 306. Center for Youth Substance Abuse Research, The University of Queensland, St Lucia, QLD, Australia
  307. 307. School of Public Health, Zhengzhou University, Zhengzhou, China
  308. 308. Institute for Health and Environment, Chongqing University of Science and Technology, Chongqing, China
  309. 309. Department of Biochemistry, BGS Global Institute of Medical Sciences, Bengaluru, India
  310. 310. Department of Maternal and Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
  311. 311. Department of Infectious Diseases and Tropical Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
  312. 312. Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, Australia
  313. 313. Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengalore, India
  314. 314. Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
  315. 315. Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
  316. 316. Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
  317. 317. Department of Health Education and Health Promotion, Kermanshah University of Medical Sciences, Kermanshah, Iran
  318. 318. Department of Sports Medicine and Rehabilitation, Kermanshah University of Medical Sciences, Kermanshah, Iran
  319. 319. Indonesian Public Health Association, Surabaya, Indonesia
  320. 320. Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom
  321. 321. Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
  322. 322. Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
  323. 323. School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
  324. 324. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
  325. 325. Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
  326. 326. Department of Dentistry, Autonomous University of Hidalgo State, Pachuca, Mexico
  327. 327. Ministry of Health, Kathmandu, Nepal
  328. 328. Peru Country Office, United Nations Population Fund (UNFPA), Lima, Peru
  329. 329. Health Technology Assessment Unit, Department of Health Philippines, Manila, Philippines
  330. 330. Center for Innovation in Medical Education, Pomeranian Medical University, Szczecin, Poland
  331. 331. Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
  332. 332. Pacific Institute for Research and Evaluation, Calverton, MD, United States
  333. 333. Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Trivandrum, India
  334. 334. Women's Social and Health Studies Foundation, Trivandrum, India
  335. 335. Internal Medicine Programme, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
  336. 336. Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan
  337. 337. Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
  338. 338. Department of Epidemiology and Biostatistics, Shahrekord University of Medical Sciences, Shahrekord, Iran
  339. 339. Health Systems and Policy Research Unit
  340. 340. Department of Surgery, Ahmadu Bello University, Zaria, Nigeria
  341. 341. Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
  342. 342. World Health Organization (WHO) Centre on eHealth, University of New South Wales, Sydney, NSW, Australia
  343. 343. Section of Plastic Surgery, University of Michigan School of Medicine, Ann Arbor, MI, United States
  344. 344. Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China
  345. 345. School of Medicine, Wuhan University, Wuhan, China
  346. 346. Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
  347. 347. Suraj Eye Institute, Nagpur, India
  348. 348. Discipline of Social and Administrative Pharmacy, University of Science, Malaysia, Penang, Malaysia
  349. 349. Mysore Medical College and Research Institute, Government Medical College, Mysore, India
  350. 350. Department of Biotechnology, University of Central Punjab, Lahore, Pakistan
  351. 351. Cardio-Aid, Bucharest, Romania
  352. 352. Bupa Clemton Park, Bupa, Sydney, NSW, Australia
  353. 353. Institute for Global Health Innovations, Duy Tan University, Hanoi, Viet Nam
  354. 354. Institute for Mental Health and Policy, Centre for Addiction and Mental Health, Toronto, ON, Canada
  355. 355. Department of Clinical Epidemiology, Institute for Clinical Evaluative Sciences, Ottowa, ON, Canada
  356. 356. Unit on Risk and Resilience in Mental Disorders
  357. 357. South African Medical Research Council, Cape Town, South Africa
  358. 358. School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
  359. 359. Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
  360. 360. Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
  361. 361. School of Social Sciences and Psychology, Western Sydney University, Penrith, NSW, Australia
  362. 362. Department of Preventive Medicine, Kyung Hee University, Dongdaemun-gu, South Korea
  363. 363. Department of Psychiatry, University of Lagos, Lagos, Nigeria
  364. 364. Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
  365. 365. Global Tobacco Control Branch, Center for Disease Control and Prevention, Atlanta, GA, United States
  366. 366. Department of Health Metrics, Center for Health Outcomes and Evaluation, Bucharest, Romania
  367. 367. Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
  368. 368. Research Department, Public Health Research Society Nepal, Kathmandu, Nepal
  369. 369. Department of Forensic Medicine and Toxicology, Pramukhswami Medical College, Anand, India
  370. 370. Department of Medical Humanities and Social Medicine, Kosin University, Busan, South Korea
  371. 371. Research and Development Department, Kalinga Institute of Medical Sciences, Bhubaneswar, India
  372. 372. Department of Genetics, Yale University, New Haven, CT, United States
  373. 373. Department of Internal Medicine, Yale University, New Haven, CT, United States
  374. 374. Pennsylvania Cancer and Regenerative Medicine Center, Baruch S Blumberg Institute, Doylestown, PA, United States
  375. 375. Department of Medicine, Xavier University School of Medicine, Woodbury, NY, United States
  376. 376. HIV and Mental Health Department, Integrated Development Foundation Nepal, Kathmandu, Nepal
  377. 377. Department of Biochemistry, Jagadguru Sri Shivarathreeswara University, Mysuru, India
  378. 378. College of Medicine, University of Central Florida, Orlando, FL, United States
  379. 379. Department of Community Medicine, Maharishi Markandeshwar Medical College and Hospital, Solan, India
  380. 380. School of Nursing and Healthcare Professions, Federation University Australia, Berwick, VIC, Australia
  381. 381. Future Technology Research Center, National Yunlin University of Science and Technology, Yunlin, Taiwan
  382. 382. Institute of Research and Development, Duy Tan University, Da Nang, Viet Nam
  383. 383. Department of Cardiology, Emory University, Atlanta, GA, United States
  384. 384. Department of Public Health, North South University, Dhaka, Bangladesh
  385. 385. Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, United States
  386. 386. Research Department, Policy Research Institute, Kathmandu, Nepal
  387. 387. Health and Public Policy Department, Global Center for Research and Development, Kathmandu, Nepal
  388. 388. University College London Hospitals, London, United Kingdom
  389. 389. Academic Public Health England, Public Health England, London, United Kingdom
  390. 390. Department of Computer Science, Boston University, Boston, MA, United States
  391. 391. Department of Clinical Research, Federal University of Uberlandia, Uberlandia, Brazil
  392. 392. Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran
  393. 393. Faculty of Medicine, Quest International University Perak, Ipoh, Malaysia
  394. 394. Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
  395. 395. Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
  396. 396. Department of Entomology, Ain Shams University, Cairo, Egypt
  397. 397. Department of Surgery, Marshall University, Huntington, WV, United States
  398. 398. Department of Geriatrics and Long Term Care, Hamad Medical Corporation, Doha, Qatar
  399. 399. Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
  400. 400. Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, United States
  401. 401. Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
  402. 402. Oral Diagnosis, Digital Health and Health Services Research, Charite, University Medical Center Berlin, Berlin, Germany
  403. 403. Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
  404. 404. College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
  405. 405. Department of Biotechnology, Mizoram University, Aizawl, India
  406. 406. Department of Family Medicine, Aga Khan University, Karachi, Pakistan
  407. 407. Karachi, Pakistan
  408. 408. Department of Community Medicine, BLDE University, Vijayapur, India
  409. 409. Centre for Medical Informatics, University of Edinburgh, Edinburgh, United Kingdom
  410. 410. National Institute of Infectious Diseases, Tokyo, Japan
  411. 411. Finnish Institute of Occupational Health, Helsinki, Finland
  412. 412. Washington State University, Pullman, WA, United States
  413. 413. Public Health Dentistry Department, Krishna Institute of Medical Sciences Deemed to be University, Karad, India
  414. 414. Department of Public Health, Arba Minch University, Arba Minch, Ethiopia
  415. 415. Department of Biomedical Sciences, Arba Minch University, Arba Minch, Ethiopia
  416. 416. Department of Psychology, Reykjavik University, Reykjavik, Iceland
  417. 417. Department of Health and Behavior Studies, Columbia University, New York, NY, United States
  418. 418. School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
  419. 419. Medicine Service, US Department of Veterans Affairs (VA), Birmingham, AL, United States
  420. 420. Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
  421. 421. Department of Pulmonary Medicine, Asthma Bhawan, Jaipur, India
  422. 422. Department of Epidemiology, School of Preventive Oncology, Patna, India
  423. 423. Department of Epidemiology, Healis Sekhsaria Institute for Public Health, Mumbai, India
  424. 424. Department No.16, Moscow Research and Practical Centre on Addictions, Moscow, Russian Federation
  425. 425. Laboratory of Genetics and Genomics, Moscow Research and Practical Centre on Addictions, Moscow, Russian Federation
  426. 426. Therapeutic Department, Balashiha Central Hospital, Balashikha, Russian Federation
  427. 427. Hull York Medical School, University of Hull, Hull City, United Kingdom
  428. 428. Division of Community Medicine, International Medical University, Kuala Lumpur, Malaysia
  429. 429. Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
  430. 430. Department of Cardiology, University of Bern, Bern, Switzerland
  431. 431. Schiller Institute, Boston College, Boston, MA, United States
  432. 432. Barcelona Institute for Global Health, Barcelona, Spain
  433. 433. Department of Statistics, Manonmaniam Sundaranar University, Abishekapatti, India
  434. 434. National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
  435. 435. Norwegian Institute of Public Health, Bergen, Norway
  436. 436. Department of Medical Sciences, Uppsala University, Uppsala, Sweden
  437. 437. The George Institute for Global Health, Sydney, NSW, Australia
  438. 438. Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
  439. 439. Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
  440. 440. Research and Development Center for Humanities and Health Management, National Institute of Health Research and Development, Jakarta, Indonesia
  441. 441. Division of Biostatistics and Epidemiology, Texas Tech University Health Sciences Center, El Paso, TX, United States
  442. 442. Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, India
  443. 443. Department of Pathology and Legal Medicine, University of Sao Paulo, Ribeirao Preto, Brazil
  444. 444. Modestum LTD, London, United Kingdom
  445. 445. Department of Health Economics, Hanoi Medical University, Hanoi, Viet Nam
  446. 446. Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India
  447. 447. Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, National Institute of Health, Rome, Italy
  448. 448. Laboratory of Toxicology, University of Crete, Heraklion, Greece
  449. 449. Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore
  450. 450. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  451. 451. Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bathinda, India
  452. 452. Department of Neurology, Infermi Hospital, Rimini, Italy
  453. 453. Department of Neurology and Stroke Unit, Sant'Anna Hospital, Como, Italy
  454. 454. Faculty of Information Technology, Ho Chi Minh City University of Technology (HUTECH), Ho Chi Minh City, Viet Nam
  455. 455. Pediatrics Department, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
  456. 456. Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Viet Nam
  457. 457. Foundation University Medical College, Foundation University Islamabad, Islamabad, Pakistan
  458. 458. Demographic Change and Aging Research Area, Federal Institute for Population Research, Wiesbaden, Germany
  459. 459. Department of Community Medicine, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
  460. 460. School of Pharmacy, Mekelle University, Mekelle, Ethiopia
  461. 461. Research and Development Center for Health Services, University of Tsukuba, Tsukuba, Japan
  462. 462. Department of Family Medicine and Community Health, Duke University, Durham, IL, United States
  463. 463. Health Services Management Research Center, Kerman University of Medical Sciences, Kerman, Iran
  464. 464. Department of Health Management, Policy, and Economics, Kerman University of Medical Sciences, Kerman, Iran
  465. 465. Human Anatomy Unit, Wollo University, Dessie, Ethiopia
  466. 466. Department of Neuropsychopharmacology, National Center of Neurology and Psychiatry, Kodaira, Japan
  467. 467. Department of Public Health, Juntendo University, Tokyo, Japan
  468. 468. Department of Health care Management and Economics, Urmia University of Medical Science, Urmia, Iran
  469. 469. School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
  470. 470. Addictology Department, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation

Source: The Lancet Public Health Published:2021


Abstract

Background: Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. Methods: We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. Findings: In 2019, 273·9 million (95% uncertainty interval 258·5 to 290·9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4·72% (4·46 to 5·01). 228·2 million (213·6 to 244·7; 83·29% [82·15 to 84·42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15–19 years was over 10% in seven locations in 2019. Although global age-standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: –1·21% [–1·26 to –1·16]), similar progress was not observed for chewing tobacco (0·46% [0·13 to 0·79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (−0·94% [–1·72 to –0·14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Interpretation: Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Funding: Bloomberg Philanthropies and the Bill & Melinda Gates Foundation. © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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