Non-communicable diseases (NCDs) contributes to more than 50 per cent disability adjusted life years (DALYs) in India; and tobacco contributes to 7·4 per cent of DALYs which is next to diet and high blood pressure. According to Global Burden of Disease (GBD) 2015, tobacco use contributed to 5.9 per cent out of total DALYs in India. Smokeless tobacco (SLT) consumption is a multifactorial process influenced by varied range of contextual factors i.e., social, environmental, psychological and the genetic factors which are linked to the tobacco use. The determinants associated with the SLT use are gender, educational level, wealth index (inverse association), urban-rural residence, socio-economic status and low tax. Taking the view from tobacco control programmes, there is a need to address determinants of SLT use with State level monitoring and socio-economic inequalities, progress and review of the taxation of the SLT use in India.
Background:
The evidence has shown that SARS CoV-2 infected patients with comorbidities are more likely to have severe disease sequel and mortality. In SARS-CoV-2 infected cancer patients risks associated with other underlying comorbidities might vary from those in non-cancer SARS CoV-2 infected patients. The relative impact of different underlying health conditions among patients with cancer and SARS CoV-2 infection remains yet to be explored. This systematic review aims to explore the prevalence of comorbidities among cancer patients with SARS CoV-2 infection and their impact on mortality.
Methods:
Online databases PubMed, Embase, Scopus and Web of science were searched for articles published between 9th July 2019 to July 8th 2020.Studies of cancer patients (>18 years) with diagnosis of SARS CoV-2 infection, published in English were included. A random-effects modelling for the meta-analyses was applied to assess the pooled prevalence and odds ratio for mortality due to comorbidities in SARS CoV-2 infected cancer patients.
Results:
Total 31studies with 4086 SARS-CoV-2 infectedcancer patientsmet the inclusion criteria. Most prevalent co-morbidities in cancer patients with SARS CoV-2 infection were hypertension [42.3% (95%CI:37.5- 47.0)], diabetes [17.8% (95% CI: 15.3-20.4)] and cardiovascular diseases [16.7% (95%CI:12.9-20.4)].The risk of mortality (pOR) was significantly higher in individuals with hypertension[1.6(95%CI 1.24-2.00)], cardiovascular diseases [2.2 (95%CI 1.49- 3.27)], chronic obstructive pulmonary diseases [1.4(95% CI 1.05-2.00)] and diabetes [1.35(95%CI 1.06-1.73)].
Conclusion:
Our results indicates that the mortality in SARS-CoV-2 infected cancer patients is affected by preexisting non-cancer comorbidities. By identifying the comorbidities predictive for mortality, clinicians can better stratify the risk of cancer patients presenting with SARS-COV-2, on their initial contact with health services.
IntroductionSettings-based approaches to health promotion, involving holistic and multidisciplinary methods, which integrate action across risk factors are important. Major advantage of focusing on these settings is the continuous and intensive contact with the participant. Despite the apparent advantages of addressing non-communicable diseases (NCDs) using targeted interventions for several developed country settings, a relative lack of evidence of effectiveness of such interventions in low/middle-income countries has led to poor allocation of resources towards these interventions. The focus is therefore on the settings rather than any one condition, and we therefore expect the findings to generalise to NCD prevention and control efforts. We intend to estimate the effectiveness of targeted interventions in low/middle-income countries.Methods and analysisWe will search PubMed, Excerpta Medica Database, OVID, WHO Library and The Cochrane Library from the year 2000 to March 2018 without language restrictions. Study designs to be included will be randomised controlled trials. The primary outcome of effectiveness will be the percentage change in population having different behavioural risk factors. Subgroup analyses will be performed, and sensitivity analyses will be conducted to assess the robustness of the findings.Ethics and disseminationNo ethical issues are foreseen. The Institute Ethics Committee of the Post Graduate Institute of Medical Education and Research approved the doctoral research protocol under which this review is being done. Dissemination will be done by submitting scientific articles to academic peer-reviewed journals. We will present the results at relevant conferences and meetings.Study designSystematic review.PROSPERO registration numberCRD42016042647; Pre-results.
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