The use of betel quid, a mixture of betel leaf, areca nut, and slaked lime, is used by one in six adults in mainland China, a survey has found.
The researchers call for urgent action to address the worryingly high rates of betel quid use, in view of its established link with oral cancer and premalignant conditions.
Betel quid is classified as a Group 1 (definite) human carcinogen by the International Agency for Research on Cancer and is associated with a range of adverse health effects, including metabolic disease, cardiovascular disease, chronic kidney disease, and low birthweight in infants.
The survey was undertaken by Tian-You Ling (Second Xiangya Hospital, Hunan Province, South-Central China) and colleagues to gauge the prevalence of betel quid chewing and oral pathology in a cross-section of the population in Hunan Province.
A total of 2356 individuals (1225 men) completed a questionnaire and underwent oral examination. Overall, 13.3% of respondents said they were current betel quid users and 2.9% said they were ex-users, giving a lifetime prevalence of 16.2%.
Further analysis revealed that the prevalence of betel quid use varied by demographics, being significantly higher in men than women (24.0 vs 1.8%), in urban than rural areas (15.4 vs 11.8%), in unmarried versus unmarried people (16.9 vs 12.2%), and in younger than older age groups, at 16.8%, 16.0%, 5.1%, and 0.6% in those aged 15-29, 30-49, 50-69, and 70 and older, respectively.
Betel quid chewing also varied by occupation, with prevalences of 16.7% in regular workers, 14.8% in irregular workers, 10.7% in students, and 2.5% in retired individuals.
Finally, betel quid use was significantly more common in people who smoked cigarettes (31.0 vs 5.2% in nonsmokers) and people who drank alcohol (30.4 vs 8.7% in teetotalers).
Factors that remained significantly, independently, and positively associated with betel quid use in multivariate analysis were male gender, urban residence, age 15-49 years, higher educational attainment, cigarette smoking, and alcohol use.
Oral examinations revealed an overall prevalence of oral submucous fibrosis (OSF) of 1.0%. Unsurprisingly, people with OSF were significantly more likely than those without this premalignant condition to be current users of betel quid, at 63.7% versus 12.8%. This disparity in betel quid use was even more pronounced in women, at 100.0% versus just 1.7%, respectively.
Commenting on their findings, Ling et al describe chewing betel quid as "a vital risk factor."
"Betel-quid chewing is linked to multidimensional health consequences, but they do not seem to be well realized in Hunan," they write.
"The increased use of this substance found among the youth offers an important message and warning for the prevention and control of OSF in Hunan."
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