Prevalence of cigarette and waterpipe smoking and associated cancer incidence among adults in the Middle East.

Abstract

Smoking is an important risk factor for various diseases, especially cancer. To estimate the prevalence of cigarette and waterpipe smoking and its association with cancer incidence in Middle Eastern countries. We searched Medline, Google Scholar, and PubMed for original articles published between 2000 and 2020 using a combination of the terms smoking, cigarettes, waterpipe, hookah, tobacco, prevalence, Middle East, and the names of countries in the Middle East. Data were analysed using STATA version 14. We performed a random-effect meta-analysis to obtain pooled smoking prevalence estimates with 95% CI and used the I² statistic to assess heterogeneity between studies. We conducted subgroup analyses by sex, country, residence, and age to explore the sources of heterogeneity, and used visual examination of the funnel plot and Egger's test to identify publication bias. We included 90 articles in this meta-analysis. The pooled prevalence of current cigarette and waterpipe smoking in Middle East countries was 17.41% and 6.92%, respectively. The prevalence of current cigarette and waterpipe smoking among men was significantly higher than among women. In the past decade, the prevalence of cigarette smoking decreased by 7.21% but the prevalence of waterpipe smoking increased by 7.80%. The highest population attributable risk was shown for oesophageal (35.0%), lung (30.50%), and gastric (8.20%) cancers. Cigarette smoking is still a public health problem especially among adult men in the Middle East. About 30% of oesophageal and lung cancers in this region were attributed to cigarette smoking. The increasing trend in waterpipe smoking during the last decade is of concern. Prevention programmes are needed as a top priority for health interventions.