Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2022; 10(10): 3131-3142
Published online Apr 6, 2022. doi: 10.12998/wjcc.v10.i10.3131
Betel quid chewing and oral potential malignant disorders and the impact of smoking and drinking: A meta-analysis
Hui-Jun Lin, Xiao-Lei Wang, Meng-Yuan Tian, Xing-Li Li, Hong-Zhuan Tan
Hui-Jun Lin, Xiao-Lei Wang, Meng-Yuan Tian, Xing-Li Li, Hong-Zhuan Tan, Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410008, Hunan Province, China
Author contributions: Lin HJ contributed to the literature search, data extraction, analysis and interpretation and manuscript drafting; Wang XL and Tian MY contributed to the literature search, data extraction and analysis; Li XL contributed to data interpretation and manuscript revision; Tan HZ contributed to data interpretation, manuscript drafting and revision; all authors read and approved the final manuscript.
Conflict-of-interest statement: The authors declare having no potential conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Zhuan Tan, MD, Full Professor, Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, No. 110 Xiangya Road, Changsha 410008, Hunan Province, China. tanhz99@qq.com
Received: July 12, 2021
Peer-review started: July 12, 2021
First decision: October 22, 2021
Revised: October 26, 2021
Accepted: February 23, 2022
Article in press: February 23, 2022
Published online: April 6, 2022
Abstract
BACKGROUND

Oral potential malignant disorders (OPMDs) are a precancerous condition of oral disease. Several studies have found that betel quid chewing, smoking and alcohol drinking might be the risk factors of OPMDs. But the relationships of them, especially their interaction are still inconclusive.

AIM

To evaluate the relationship between betel quid chewing and OPMDs and to explore the interaction of smoking and alcohol drinking on the relationship.

METHODS

We searched PubMed, Web of Science, Embase and the Cochrane Library databases with items complete until January 2021 for relevant studies. The research data were extracted according to the inclusion criteria. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to evaluate the effect size. Subgroup analysis was performed to assess interactions between exposures and OPMDs. Relative excess risk of interaction (RERI) was used to estimate the size of interaction.

RESULTS

Nine articles were selected in the final meta-analysis. The results showed that betel quid chewing (pooled OR: 8.70, 95%CI: 5.18-14.61), alcohol consumption (pooled OR: 1.95, 95%CI: 1.5-2.55), and smoking (pooled OR:4.35, 95%CI: 3.06-6.2) could significantly increase the risk of OPMDs compared to individuals without these behaviors. Smoking and alcohol drinking synergistically increased the association between betel quid chewing and OPMDs (pooled OR(BQ+SM):14.38, 95%CI: 7.14-28.95; pooled OR(BQ+DK): 11.12, 95%CI: 8.00-15.45, respectively). The RERI(BQ+SM) and RERI(BQ+DK) were 2.33 and 1.47, respectively.

CONCLUSION

The synergistic effects between smoking/drinking and betel quid highlights the importance of focusing on individuals with multiple exposures. Further study should be conducted to confirm these interactions.

Keywords: Oral potential malignant disorders, Betel quid chewing, Smoking, Drinking, Synergistic effect

Core Tip: Betel quid chewing, smoking and drinking could significantly increase the risk of oral potential malignant disorders (OPMDs). And smoking and drinking synergistically increased the association between betel quid chewing and OPMDs.