Global Burden of Green Tobacco Sickness in Farm Workers: A Systematic Review and Meta-Analysis of Prevalence, Gender Disparities, and Socio-Economic Determinants.

Abstract

Green Tobacco Sickness (GTS) represents a subcategory of an occupational illness defined by nicotine dermal absorption among tobacco workers. This study aimed to assess the global prevalence of GTS, explore gender and socio-economic inequalities, and investigate temporal patterns for informing policy and preventive strategies. A meta-analysis and systematic review was conducted as per PRISMA guidelines. Databases like PubMed/MEDLINE, Web of Science, and Scopus were searched. Studies that report GTS prevalence, containing observational data, were selected. The data extraction process included study design, demographic data, and prevalence. Meta-regression was conducted to determine the impact of factors such as human development index (HDI), year of publication, and development category on pooled prevalence rate estimates, while overall pooled prevalence was calculated by random effects model. Publication bias was measured using funnel plots and Egger's test. Based on the 17 studies (17,609 workers), the estimated global prevalence of GTS stood at 23.6% (95% CI: 15.4%-34.5%) Women had higher prevalence (37.3%: 95% CI: 19.0%-60.2%) than men (21.7%: 95% CI: 11.4%-37.5%). Meta-regression analysis found an association of lower prevalence rates with higher HDI, GTS prevalence was higher in countries with lower HDI (β = -8.59, <i>P</i> < 0.001). No considerable publication bias was found to exist (Egger's test: <i>P</i> = 0.446). As the prevalence of GTS has increased, this calls for action to be taken to rectify the deterioration of working conditions such as the provision of protective equipment and gendered health care policies that mitigate the health risks of women who smoke and work as GTS.