Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2020 Aug 12;18(1):222.
doi: 10.1186/s12916-020-01677-9.

Global burden of disease due to smokeless tobacco consumption in adults: an updated analysis of data from 127 countries

Kamran Siddiqi  1   2 , Scheherazade Husain  3 , Aishwarya Vidyasagaran  3 , Anne Readshaw  3 , Masuma Pervin Mishu  3 , Aziz Sheikh  4
Affiliations
Multicenter Study

Global burden of disease due to smokeless tobacco consumption in adults: an updated analysis of data from 127 countries

Kamran Siddiqi et al. BMC Med. .

Abstract

Background: Smokeless tobacco (ST) is consumed by more than 300 million people worldwide. The distribution, determinants and health risks of ST differ from that of smoking; hence, there is a need to highlight its distinct health impact. We present the latest estimates of the global burden of disease due to ST use.

Methods: The ST-related disease burden was estimated for all countries reporting its use among adults. Using systematic searches, we first identified country-specific prevalence of ST use in men and women. We then revised our previously published disease risk estimates for oral, pharyngeal and oesophageal cancers and cardiovascular diseases by updating our systematic reviews and meta-analyses of observational studies. The updated country-specific prevalence of ST and disease risk estimates, including data up to 2019, allowed us to revise the population attributable fraction (PAF) for ST for each country. Finally, we estimated the disease burden attributable to ST for each country as a proportion of the DALYs lost and deaths reported in the 2017 Global Burden of Disease study.

Results: ST use in adults was reported in 127 countries; the highest rates of consumption were in South and Southeast Asia. The risk estimates for cancers were also highest in this region. In 2017, at least 2.5 million DALYs and 90,791 lives were lost across the globe due to oral, pharyngeal and oesophageal cancers that can be attributed to ST. Based on risk estimates obtained from the INTERHEART study, over 6 million DALYs and 258,006 lives were lost from ischaemic heart disease that can be attributed to ST. Three-quarters of the ST-related disease burden was among men. Geographically, > 85% of the ST-related burden was in South and Southeast Asia, India accounting for 70%, Pakistan for 7% and Bangladesh for 5% DALYs lost.

Conclusions: ST is used across the globe and poses a major public health threat predominantly in South and Southeast Asia. While our disease risk estimates are based on a limited evidence of modest quality, the likely ST-related disease burden is substantial. In high-burden countries, ST use needs to be regulated through comprehensive implementation of the World Health Organization Framework Convention for Tobacco Control.

Keywords: Cancer; Chewing; Ischaemic heart disease; Mouth; Oesophagus; Oral; Pharynx; Smokeless tobacco.

PubMed Disclaimer

Conflict of interest statement

None declared

Figures

Fig. 1
Fig. 1
Smokeless tobacco prevalence among men and women
Fig. 2
Fig. 2
Risk estimates for oral cancers among ever ST users
Fig. 3
Fig. 3
Risk estimates for cardiovascular diseases (ischaemic heart disease, stroke) among ever ST users
Fig. 4
Fig. 4
a Countries with a proportional change in female ST use between 2015 and 2020 estimates. b Countries with a proportional change in male ST use between 2015 and 2020 estimates
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. National Cancer Institute and Centers for Disease Control and Prevention. Smokeless tobacco and public health: a global perspective. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Institutes of Health, National Cancer Institute; 2014. Bethesda, MD NIH Publication No 14–-7983. https://cancercontrol.cancer.gov/brp/tcrb/global-perspective/SmokelessTo....
    1. Moghbel N, Ryu B, Cabot PJ, Ratsch A, Steadman KJ. In vitro cytotoxicity of Nicotiana gossei leaves, used in the Australian Aboriginal smokeless tobacco known as pituri or mingkulpa. Toxicol Lett. 2016;254:45–51. - PubMed
    1. Maki J. The incentives created by a harm reduction approach to smoking cessation: snus and smoking in Sweden and Finland. Int J Drug Policy. 2015;26:569–574. - PubMed
    1. Palipudi K, Rizwan SA, Sinha DN, Andes LJ, Amarchand R, Krishnan A, et al. Prevalence and sociodemographic determinants of tobacco use in four countries of the World Health Organization: South-East Asia region: findings from the Global Adult Tobacco Survey. Indian J Cancer. 2014;51(Suppl 1):S24–S32. - PubMed
    1. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, World Health Organization, International Agency for Research on Cancer. Smokeless Tobacco and Some Tobacco-specific N-nitrosamines. Lyon: World Health Organization; 2007. https://monographs.iarc.fr/wp-content/uploads/2018/06/mono89.pdf.

Publication types