90% of Chewing Tobacco Health Burden in 10 Countries, Including India: Study

New Delhi: India is among the top countries with 90 per cent of the world's chewing tobacco-related health burden, and South Asia is the "epicentre" of chewing tobacco, according to new research published in The Lancet Global Health journal.

Researchers estimated that chewing tobacco contributed to 251,000 deaths globally in 2023 -- there were 241 million chewing tobacco users globally, with use peaking among individuals 60 to 64 years old, they said.

The analysis, part of the Global Burden of Disease Study 2023 (GBD 2023) and covering 204 countries and territories from 1990 to 2023, distinguishes the burden of chewing tobacco from that of other forms of smokeless tobacco, the team said.

"Chewing tobacco is not a uniform public health problem, and our findings show that a relatively small number of countries bear an overwhelming share of its health burden," lead author Gabriela Gil, research scientist at Institute for Health Metrics and Evaluation (IHME), University of Washington, US, said.

"Understanding how patterns of use differ within these populations is critical to designing more effective prevention and tobacco control strategies," Gil said.

The researchers said despite decades of progress in tobacco control, the global prevalence of chewing tobacco use has remained relatively unchanged. Stroke and lip and oral cavity cancer were found to comprise much of the health loss attributable to chewing tobacco use globally.

South Asia had the highest concentration of chewing tobacco use, with 14.6 per cent of people aged 15 years and above chewing tobacco products in 2023.

The region accounted for 2,10,000 chewing tobacco-related deaths -- about 84 per cent of the global total, the study estimated.

However, more than 90 per cent of chewing tobacco-related deaths and disability burden among men was found to occur in 10 countries, including India, Bangladesh, China, Pakistan and the US.

Among women, more than 90 per cent of the burden was concentrated in countries, including India, Bangladesh, Pakistan, Indonesia, Myanmar and China.

The researchers said the figures reflect total deaths and disability, meaning countries with larger populations may account for a greater share of the burden even if their rates are not the highest.

Patterns of chewing tobacco use also varied substantially by age and sex.

"These findings show why chewing tobacco control cannot take a one-size-fits-all approach," senior author Emmanuela Gakidou, professor in the department of health metrics sciences at IHME, said.

"Prevention and cessation strategies need to reflect how patterns of use differ by country, age, and sex, as well as the cultural and social factors that shape tobacco use in each setting," Gakidou said.