Daijiworld Media Network - New Delhi

New Delhi, Oct 1: Chewing tobacco use contributed to an estimated 251,000 deaths worldwide in 2023, with the health burden overwhelmingly concentrated in South Asia, according to a new study by the Institute for Health Metrics and Evaluation (IHME).

The analysis, part of the Global Burden of Disease Study 2023 and published in The Lancet Global Health, assessed chewing tobacco-related health burden across 204 countries and territories from 1990 to 2023. Researchers distinguished chewing tobacco from other forms of smokeless tobacco that are often grouped together.

An estimated 241 million people aged 15 and above used chewing tobacco in 2023, representing 3.9% of the global population in that age group. Use was more than twice as prevalent among males as females. Researchers found no country recorded a significant decline in the number of users between 1990 and 2023, while 24 countries recorded significant increases.

South Asia remained the main centre of chewing tobacco use, with 14.6% of people aged 15 and above using such products in 2023. The region accounted for an estimated 210,000 deaths, around 84% of the global total.

At the country level, age-standardised prevalence was highest in Palau at 24.4%, followed by Bangladesh at 23.4% and Nepal at 17.5%.

More than 90% of chewing tobacco-related deaths and disability among males occurred in 10 countries — India, Bangladesh, China, Pakistan, Myanmar, the United States, Nepal, Sri Lanka, the Philippines and Madagascar. Among females, more than 90% of the burden was concentrated in India, Bangladesh, Pakistan, Indonesia, Myanmar, China, Thailand, Cambodia, Vietnam and Nepal.

The researchers said the pattern of use varied considerably by age and sex. Globally, chewing tobacco use increased from early adulthood and continued rising with age before peaking among people aged 60 to 64.

In South Asia, nearly one in five males and one in 10 females used chewing tobacco in 2023. Among males, use peaked at ages 60 to 64, while among females it peaked among those aged 80 and above.

Patterns differed between countries. In Bangladesh, chewing tobacco use was higher among females than males across all age groups above 30, although use remained common among both sexes.

The study assessed the health risks associated with chewing tobacco across six outcomes, including stroke, lip and oral cavity cancer, oesophageal cancer, other pharyngeal cancers, laryngeal cancer and nasopharyngeal cancer.

Stroke accounted for the largest share of chewing tobacco-related health loss globally, at 55.9 disability-adjusted life-years (DALYs) per 100,000 people, followed by lip and oral cavity cancer at 17.4 DALYs per 100,000. DALYs measure overall health loss by combining years lost due to premature death and years lived with disability.

Chewing tobacco accounted for 17.3% of lip and oral cavity cancer DALYs globally, rising to 30.5% in South Asia.

The number of DALYs attributed to chewing tobacco increased by 116% between 1990 and 2023, reaching 6.48 million globally. Premature death accounted for 6.17 million of those years of life lost in 2023.

Researchers said the findings highlight the need to strengthen smokeless tobacco prevention and cessation measures as part of national tobacco-control and non-communicable disease strategies.

The study's authors also stressed that prevention and cessation programmes need to take into account differences in chewing tobacco use by country, age and sex, as well as the social and cultural factors influencing consumption. IHME's Global Burden of Disease programme is designed to measure health loss across diseases, injuries and risk factors worldwide.