Table 1.
Epidemiology studies of BQ usage related multidimensional health effects.
| Health effects | Location (year) | Study design | Number of cases | Number (%)a of BQ | Number of controls | Number (%) of BQ | aOR (95% CI) | Ref. |
|---|---|---|---|---|---|---|---|---|
| Oral cancer | Kaohsiung, Taiwan (1992-93) |
Case-control study (N = 307) |
107 (M/F = 104/3) |
Never: 31 (29%) Former: 5 (5%) Current: 71 (66%) |
200 (M/F = 194/6) |
Never: 153 (77%) Former: 5 (3%) Current: 42 (21%) |
BQ only: 28.2 (1.9–414.4)∗ A + BQ + C: 122.8 (171.1–880.5)∗ |
[10] |
|
| ||||||||
| Pharyngeal cancer | Kaohsiung, Taiwan (2000–03) |
Case-control study (n = 501): frequency matched males >= 40 yr |
148 (M = 148) |
Never: 33 (22%) Former: 44 (30%) Current: 71 (48%) |
255 (M = 255) |
Never: 216 (85%) Former: 11 (4%) Current: 28 (11%) |
7.7 (4.1–15.0)∗ | |
|
| ||||||||
| Oral leukoplakia | Kaohsiung, Taiwan (1994-95) |
Case-control study (N = 1095) |
125 (M/F = 118/7) |
Never: 19 (15%) Former: 6 (5%) Current: 100 (80%) |
500 (M/F = 472/28) |
Never: 258 (52%) Former: 16 (3%) Current: 226 (45%) |
22.3 (11.3–43.8)∗ | [18] |
|
| ||||||||
| Oral submucous fibrosis |
94 (M/F = 93/1) |
Never: 10 (11%) Former: 5 (5%) Current: 79 (84%) |
376 (M/F = 372/4) |
Never: 188 (50%) Former: 14 (4%) Current: 174 (46%) |
40.7 (16.0–103.7)∗ | |||
|
| ||||||||
| Laryngeal cancer | Kaohsiung, Taiwan (2000–03) |
Case-control study (n = 501): frequency matched males >= 40 yr |
128 (M = 128) |
Never: 85 (66%) Former: 15 (12%) Current: 28 (22%) |
255 | 1.3 (0.7–2.5) | [12] | |
|
| ||||||||
| Esophageal cancer | Kaohsiung, Taiwan (2005) |
Case-control study (N = 420): age, sex matched males (>= 40 yr) |
165 (M = 165) |
Never: 72 (44%) Former: 31 (19%) Current: 62 (38%) |
255 (M = 255) |
Never: 216 (85%) Former: 11 (4%) Current: 28 (11%) |
1.7 (0.8–3.1) Chewed with a piece of betel inflorescence: 4.2 (1.4–16.0)∗ Swallowed BQ juice: 3.3 (1.3–9.3)∗ |
[21] |
|
| ||||||||
| Hepatocellular carcinoma (HCC) |
Kaohsiung, Taiwan (1996-97) |
Case-control study (N = 526): matched by sex and age (±3 years) |
263 (M/F = 205/58) |
Never: 192 (73%) Ever: 71 (27%) |
263 (M/F = 205/58) |
Never: 241 (92%) Ever: 22 (8%) |
3.49 (1.74–6.96)∗ | [22] |
|
| ||||||||
| Hepatocellular carcinoma (HCC) | Taiwan (2003) |
Community-based cohort study | 11837 (M = 11837) | Never: 10,388 (88%) Ever: 1449 (12%) |
Compared with non-BQ chewers with HBsAg(−): BQ chewers with HBsAg(−): 3.43 (1.19–9.89) |
[41] | ||
|
| ||||||||
| Cirrhosis | Kaohsiung, Taiwan (1996-97) |
210 (M/F = 170/40) |
Never: 176 (84%) Ever: 34 (16%) | 210 (M/F = 170/40) |
Never: 199 (95%) Ever: 11 (5%) |
3.56 (1.41–8.96)∗ | [25] | |
|
| ||||||||
| HCC complicating cirrhosis |
Kaohsiung, Taiwan (1996-97) |
Case-control study (N = 630): matched by sex and age (±5 yr) |
[23] | |||||
| Cirrhosis with HCC |
210 (M/F = 170/40) |
Never: 158 (75%) Ever: 52 (25%) |
210 (M/F = 170/40) |
Never: 199 (95%) Ever: 11 (5%) |
Compared with controls: 5.81 (2.26–14.94)∗ |
|||
| Compared with cirrhosis alone: 1.69 (1.04–2.76)∗ |
||||||||
|
| ||||||||
| Adverse birth outcomes | East, Taiwan (1998) |
Case-control study (N = 229) |
F = 32 | Never: 10 (31%) Ever: 22 (69%) | F = 197 | Never: 101 (51%) Ever: 96 (49%) | Low birth weight: 9.1 (1.6–51.8)∗ Preterm birth: 3.4 (1.1–11.4)∗ |
[38] |
|
| ||||||||
| Adverse pregnancy outcomes | Taiwan Bunum aborigine (1994) |
Cross-sectional study: DOH-HR survey (age-matched) (N = 186) |
Adverse pregnancy: 62 (F = 62) Never-adverse pregnancy: 124 (F = 124) |
Never: 35 (56.4%) Ever: 27 (43.6%) |
Adverse pregnancy outcomes: 2.8 (1.2–6.8)∗ |
[42] | ||
|
| ||||||||
| Lower birth weight (LBW) |
South and East, Taiwan (2003-04) |
Cross-sectional study: hospital-based (N = 1264) |
1264 | Never: 800 (63%) Ever: 464 (37%) |
LBW: 2.40 (1.21–4.80) |
[37] | ||
|
| ||||||||
| Full-term LBW |
Full-term LBW: 3.67 (1.70–7.96) |
|||||||
|
| ||||||||
| Lower male newborn rate |
Male newborn: 0.62 (0.43–0.89) |
|||||||
|
| ||||||||
| Asthma | Kaohsiung, Taiwan (2013) |
Case-control study (N = 1800) (age- and gender-matched community controls) | 600 | M: Never: 192 (75%) Ever: 63 (25%) F: Never: 340 (99%) Ever: 5 (1%) |
1200 | M: Never: 426 (84%) Ever: 84 (16%) F: Never: 689 (99.9%) Ever: 1 (0.1%) |
Current chewers: 2.05 (1.12–3.76)∗ | [40] |
|
| ||||||||
| Metabolic syndrome | Taiwan (1993–96) |
Cross-sectional study: nutrition and health survey (NAHSIT) (N = 1986) |
1986 (M/F = 920/1066) |
M: Never: 634 (69%) Ever: 286 (31%) F: Never: 984 (92%) Ever: 82 (8%) |
Metabolic syndrome: 1.31 (1.12–1.55)∗ (BQ consumption 10 times/day) Abdominal obesity: 1.42 (1.2–1.68)∗ Hypertriacylglycerolemia: 1.33 (1.02–1.73)∗ High blood pressure: 2.0 (1.4–3.0)∗ (only in females) |
[27] | ||
|
| ||||||||
| Metabolic syndrome |
Keelung, Taiwan (2001–03) |
Cross-sectional study: Keelung community-based integrated screening (KCIS) program (N = 19866) |
19866 (M = 19866) |
M: Never: 16874 (85%) Former: 1569 (8%) Current: 1423 (7%) |
Former: Metabolic syndrome: 1.38 (1.19–1.61)∗ Hyperglycemia: 1.07 (0.87–1.31) Hypertriacylglycerolemia: 1.40 (1.23–1.61)∗ Current: Metabolic syndrome: 1.78 (1.53–2.08)∗ Hyperglycemia: 1.24 (1.09–1.64)∗ Hypertriacylglycerolemia: 1.90 (1.66–2.19)∗ |
[26] | ||
|
| ||||||||
| Type 2 DM | Keelung, Taiwan (1999–2001) |
Cross-sectional study: KCIS program (N = 14816) |
14816 (M = 14816) |
M: Never: 12696 (86%) Ever: 2120 (14%) |
Type 2 DM: 1.29 (1.04–1.60)∗ | [28] | ||
|
| ||||||||
| Obesity | Taiwan aborigines (2003-04) |
Cross-sectional study: large-scale survey of substance use (N = 7144) |
7144 (M/F = 3824/3320) |
M: Never: 1791 (47%) Former: 167 (4%) Current: 1866 (49%) F: Never: 2062 (62%) Former: 84 (3%) Current: 1174 (35%) |
Obesity: 1.61 (1.40–1.85)∗ | [43] | ||
|
| ||||||||
| Heart disease | Taiwan (1993–96) |
Cross-sectional study: nutrition and health survey (N = 1932) (NAHSIT) |
1932 M/F = 896/1036 |
M: Never: 619 (69%) Ever: 277 (31%) F: Never: 957 (92%) Ever: 79 (8%) |
Heart disease: 1.37 (1.1–1.6)∗ (BQ consumption 10 times/day; only in females) | [32] | ||
|
| ||||||||
| Cardiovascular disease (CVD) All-cause mortality |
Taiwan (1998-99) |
Cross-sectional study: MJ health screening centers (N = 56116) follow-up study |
56116 (M = 56116) |
Never: 44565 (79%) Former: 5568 (10%) Current: 5983 (11%) |
Former: CVD: 1.56 (1.02–2.38) All-cause mortality: 1.40 (1.17–1.68) Current: CVD: 2.02 (1.31, 3.13) All-cause mortality: 1.40 (1.16, 1.70) |
[30] | ||
|
| ||||||||
| Cardiovascular disease (CVD) |
Keelung, Taiwan (1999–2004) |
Cross-sectional study: KCIS program (N = 21906) |
21906 (M = 21906) |
Never: 17976 (82%) Former: 1830 (8%) Current: 2100 (10%) |
Ever: CVD: 1.24 (1.11–1.39)∗ |
[31] | ||
|
| ||||||||
| Cardiovascular disease (CVD) |
New Taipei, (2013) |
Cross-sectional study (hospital-based) |
3177 (M/F = 2002/1175) |
M: Never: 1761 (88%) Ever: 241 (12%) F: Never: 1167 (99.3%) Ever: 8 (0.7%) |
Ever: CVD risk factors: Obesity: 1.43 (1.07–1.91) Central obesity: 2.27 (1.53–3.37) hs-CRP level: 1.38 (1.03–1.85) |
[44] | ||
|
| ||||||||
| Obesity metabolic syndrome Type 2 diabetes mellitus (DM) Cardiovascular disease (CVD) All-cause mortality |
17 Asia studies (5 cohort, and 12 case-control studies) (1951–2013) |
Meta-analysis (N = 121585) |
Obesity (N = 30623) metabolic syndrome (N = 23291) DM (N = 51412) CVD (N = 201488) All-cause mortality (N = 179582) Hypertension (N = 89051) |
Obesity: 1.47 (1.23–1.75)∗ Metabolic syndrome: 1.51 (1.09–2.10)∗ Type 2 DM: 1.47 (1.20–1.81)∗ CVD: 1.2 (1.03–1.40)∗ All-cause mortality: 1.21 (1.04–1.42)∗ Hypertension: 1.45 (0.98–2.15) |
[45] | |||
|
| ||||||||
| All causes Cancers |
Araihazar, Bangladesh (2000–02) |
Cohort study (N = 19999) | 19999 (M/F = 8148/11851) |
M: Never: 5010 (61%) Former: 288 (4%) Current: 2850 (35%) F: Never: 7989 (67%) Former: 177 (2%) Current: 3685 (31%) |
Ever chewers: All causes: 1.26 (1.09–1.44)∗ Cancers: 1.55 (1.09–2.22)∗ Cardiovascular disease: 1.16 (0.93–1.43) |
[34] | ||
|
| ||||||||
| Total death Cerebrovascular deaths |
Taiwan (1989–96) | Cohort study (N = 6503) | 6503 (M/F = 3577/2926) |
Never: 5602 (44%) Former: 373 (19%) Current: 528 (38%) |
Total death: 1.19 (1.05–1.35) Cerebrovascular deaths: 1.66 (1.19–2.30) |
[35] | ||
|
| ||||||||
| Schizophrenia | Palau (1998) |
Cross-sectional study: hospital-based study (N = 70) |
70 (M/F = 49/21) |
M: Never: 26 (53%) Ever: 23 (47%) F: Never: 4 (19%) Ever: 17 (81%) |
BQ chewing associated with milder symptom schizophrenia | [46] | ||
|
| ||||||||
| Schizophrenia | Palau (2002–04) |
Cohort study: (N = 65) | 65 (M/F = 45/20) |
Never: 16 (25%) Ever: 49 (75%) |
Male BQ chewers with high-consumption had significantly milder positive symptoms than BQ chewers with low-consumption | [47] | ||
aMay not total 100% due to rounding. A: alcohol drinking; B: betel quid chewing; C: cigarette smoking; never: never-chewers; former: former chewers (withdraw BQ); current: current chewers; ever: ever chewers (former chewers combined current chewers); ref.: reference; DM: diabetes mellitus; hs-CRP: high-sensitivity C-reactive protein; CVD: cardiovascular disease. ∗ indicates a statistically significant difference (p < 0.05).