The effects of waterpipe tobacco smoking on health outcomes: an updated systematic review and meta-analysis
Author(s)
Waziry, R
Jawad, M
Ballout, RA
Al Akel, M
Akl, EA
Type
Journal Article
Abstract
BACKGROUND AND AIMS: A systematic review conducted in 2008 found significant associations between waterpipe tobacco smoking and lung cancer, respiratory disease, periodontal disease and low birthweight. Since then, a number of relevant studies have been published. The objective of this study was to update the systematic review on the effects of waterpipe tobacco smoking on health outcomes. METHODS: In May 2015 we electronically searched the following databases with no date restrictions: MEDLINE, EMBASE and the ISI Web of Science using a detailed search strategy with no language restrictions. We also screened the references' lists of the included studies. We included cohort, case-control and cross-sectional studies, and excluded case reports, conference abstracts, editorials and reviews. We excluded studies not conducted in humans, assessing physiological outcomes, not distinguishing waterpipe tobacco smoking from other forms of smoking or not reporting association measures. We assessed risk of bias for each included study and conducted meta-analyses for each of the outcomes of interest. RESULTS: We identified 50 eligible studies. We found that waterpipe tobacco smoking was significantly associated with: respiratory diseases [COPD; odds ratio (OR) = 3.18, 95% confidence interval CI = 1.25, 8.08; bronchitis OR = 2.37, 95% CI = 1.49, 3.77; passive waterpipe smoking and wheeze OR) = 1.97, 95% CI = 1.28, 3.04]; oral cancer OR = 4.17, 95% CI = 2.53, 6.89; lung cancer OR = 2.12, 95% CI = 1.32, 3.42; low birthweight (OR = 2.39, 95% CI = 1.32, 4.32); metabolic syndrome (OR 1.63-1.95, 95% CI = 1.25, 2.45); cardiovascular disease (OR = 1.67, 95% CI = 1.25, 2.24); and mental health (OR 1.30-2.4, 95% CI = 1.20, 2.80). Waterpipe tobacco smoking was not significantly associated with: oesophageal cancer (OR = 4.14, 95% CI = 0.93, 18.46); worse quality of life scores [standardized mean difference (SMD) = -0.16, 95% CI = -0.66, 0.34]; gastric carcinoma (OR = 2.16, 95% CI = 0.72, 6.47); bladder cancer (OR = 1.25, 95% CI = 0.99, 1.57); prostate cancer (OR = 7.00, 95% CI = 0.90, 56.90); hepatitis C infection (OR = 0.98, 95%0.80, 1.21); periodontal disease (OR = 3.00, 5.00); gastro-oesophageal reflux disease (OR = 1.25, 95% CI = 1.01, 1.56); nasopharyngeal carcinoma (OR = 0.49, 95% CI = 0.20, 1.23); bladder cancer (OR = 1.25, 95% CI = 0.99, 1.57); infertility (OR = 2.50, 95% CI = 1.00, 6.30); and mortality (OR = 1.15, 95% CI = 0.93, 1.43). CONCLUSIONS: There is accumulating evidence about the association of waterpipe tobacco smoking with a growing number of health outcomes.
Date Issued
2016-04-13
Date Acceptance
2016-01-20
Citation
International Journal of Epidemiology, 2016, 46 (1), pp.32-43
ISSN
1464-3685
Publisher
Oxford University Press (OUP)
Start Page
32
End Page
43
Journal / Book Title
International Journal of Epidemiology
Volume
46
Issue
1
Copyright Statement
© The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association. This is a pre-copyedited, author-produced PDF of an article accepted for publication in International Journal of Epidemiology following peer review. The version of record Reem Waziry, Mohammed Jawad, Rami A. Ballout, Mohammad Al Akel, and Elie A Akl The effects of waterpipe tobacco smoking on health outcomes: an updated systematic review and meta-analysis Int. J. Epidemiol. first published online April 13, 2016 is available online at: https://dx.doi.org/10.1093/ije/dyw021
Identifier
PII: dyw021
Subjects
Waterpipe tobacco smoking
health effects
systematic review
Publication Status
Published