Social Characteristics and Community Disparities in Chewing Betel and Mortality in Taiwanese Men: A...

In Taiwan, oral cancer mortality is ≥5-fold higher in the community with the highest rate compared to the community with the lowest rate. However, little is known about the community disparity in health relevant to chewing betel in Taiwan and the social background of this disparity.

A community-correlation study was conducted with data on social characteristics, male current chewing betel, and male mortality in each city/county of Taiwan. Data were collected via government websites open for public use. To explore the correlations of social characteristics with chewing betel and mortality at the community level, we calculated Spearman's rank correlation coefficients.

Prevalence of current chewing betel among men aged ≥18 years in 2017 in each city/county ranged from 3.1% to 19.2%. A significant positive correlation was found between chewing betel and age-standardized all-cause mortality in 2021-2022 among the 22 cities/counties (r=0.81, P<0.001). Types of cause-specific mortality with which chewing betel had positive correlations were malignant neoplasm (r=0.67, P<0.001), oral cancer (r=0.81, P<0.001), liver cancer (r=0.57, P=0.006), lung cancer (r=0.54, P=0.01), heart disease (r=0.51, P=0.02), stroke (r=0.69, P<0.001), chronic hepatitis/liver cirrhosis (r=0.75, P<0.001), nephritis/nephropathy (r=0.60, P=0.003), accident/injury (r=0.79, P<0.001), and suicide (r=0.65, P=0.001). Betel plantation area per person (r=0.75, P<0.001), betel sales stores per person (r=0.68, P<0.001), junior high school graduate or less (r=0.53, P=0.01), and low and low-middle household income (r=0.43, P=0.047) in 2017 correlated positively with chewing betel.

Regional differences in betel plantation area, betel sales stores, low education, and low household income contributed to community disparities in chewing betel and health in Taiwanese men.