Spirometry-Assessed Obstructive Airway Disease and Its Determinants among Male Bidi and Cigarette Smokers in Rural Odisha, India: A Community-Based Cross-Sectional Study

Abstract

Background: Tobacco smoking, particularly bidi use, is highly prevalent in rural India and is associated with significant respiratory and cardiovascular morbidity. The purpose was to compare spirometry parameters between bidi and cigarette smokers, estimate the prevalence of obstructive airway disease (OAD), and assess its association with blood pressure among male smokers. Methods: A community-based cross-sectional study was conducted among 355 male smokers aged 20-60 years in rural Odisha. Spirometry was performed in accordance with ATS/ERS guidelines. OAD was defined as FEV₁/FVC <0.70. Statistical analysis included chi-square test, independent t-test, and binary logistic regression. Results: The prevalence of OAD was 43.6% (95% CI: 38.5-48.8). OAD was significantly higher among bidi smokers compared to cigarette smokers (66.9% vs. 21.9%, p <0.001). Bidi smokers had significantly lower FEV₁ and FEV₁/FVC ratio. Participants with OAD had higher systolic (131±6 mmHg vs. 122±7 mmHg) and diastolic (85±5 mmHg vs. 79±5 mmHg) blood pressure (p<0.001). Conclusion: Obstructive airway disease (OAD) was common among rural male smokers, affecting 43.6% of participants. The condition was much more prevalent in bidi smokers at 66.9%, compared to 21.9% in cigarette smokers, highlighting the greater airflow restriction and respiratory problems linked to bidi use. These results emphasise the importance of implementing targeted tobacco control, spirometry screening, and early intervention strategies in rural areas.