Researchers led by Keenan Duggal of NYU Grossman School of Medicine report that habitual users faced markedly higher odds of respiratory-related death, independent of
cigarette smoking and other known risk factors.
The team tracked 20,033 adults aged 18 to 75 years from Araihazar, Bangladesh, over a follow-up period spanning October 2000 to April 2024. During this time, 476 participants died from respiratory illnesses. Baseline information—including age, sex, education, body mass index, smoking history, and detailed patterns of betel quid use—was collected through standardized questionnaires. Using Cox proportional hazards models, the investigators assessed how betel quid habits influenced the likelihood of dying from respiratory conditions.
The analysis revealed the following findings:
- Individuals who had ever chewed betel quid showed a 38% higher risk of death from respiratory disease compared with non-users (hazard ratio [HR] 1.38).
- COPD-related mortality risk increased by 56% among betel quid users (HR 1.56).
- No significant association was observed between betel quid use and lung cancer mortality (HR 1.24).
- A dose–response trend was evident:
- Low levels of betel quid consumption were linked to a 46% higher risk of COPD mortality (HR 1.46).
- Heavy use was associated with more than double the risk (HR 2.47) compared with never users.
- These associations persisted regardless of demographic or lifestyle factors and were particularly pronounced among:
- Women (HR 3.63)
- Non-smokers (HR 3.44)
- The researchers estimated that 16% of COPD deaths in the cohort could be attributed to betel quid use.
Betel quid—a preparation typically containing areca nut, slaked lime, and often tobacco—has long been linked to oral cancers and cardiovascular disease. The study adds strong prospective evidence that its harm extends to chronic respiratory illnesses as well. Because the analysis adjusted for smoking, body weight, education level, and other potential confounders, the findings underscore betel quid as an independent risk factor for fatal COPD.
The authors call for urgent public health measures to curb betel quid consumption, highlighting the need for community education, clinical screening, and policy interventions. With millions of users across Asia and migrant communities worldwide, they warn that failing to address this habit could exacerbate the global burden of respiratory disease.
The study provides some of the most robust data to date on the lethal respiratory consequences of betel quid, reinforcing the call for clinicians and policymakers to treat this culturally ingrained practice as a serious health hazard.
Reference:
Duggal, K., Wu, F., Parvez, F., Ahmed, A., Hasan, R., Shima, S. A., Sarwar, G., Rakibuz-Zaman, M., Ahmmed, G., Shahriar, M. H., Ahsan, H., & Chen, Y. (2025). Association between betel quid consumption and respiratory disease mortality in a prospective Bangladeshi cohort. CHEST. https://doi.org/10.1016/j.chest.2025.08.030
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