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

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 countryspecific 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 STrelated 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.

Disparities in smokeless tobacco use in Bangladesh, India, and Pakistan: Findings from the Global Adult Tobacco Survey, 2014-2017

“…This estimate excludes Europe, where studies showed no statistically significant association between all-cause mortality and SLT use. South East Asian Region carried the major proportion (88%) of this burden [7]. "…”

The Progression of the Tobacco Epidemic in India on the National and Regional Levels, 1998-2016

“…On a national level in India, smokeless tobacco consumption follows the trends for tobacco smoking, and therefore ts into the classical smoking epidemic framework. Although the maximum levels of smokeless tobacco use prevalence (19.28% for men and 5.06% for women) have been substantially lower in India than in other countries 42 , they were higher than the prevalence of tobacco smoking for all of the time points, particularly for women. Thus, the use of smokeless tobacco cannot be ignored when studying the tobacco epidemic in India.…”

An integrated approach for identification of a panel of candidate genes arbitrated for invasion and metastasis in oral squamous cell carcinoma

“…So according to this data male are on higher risk of incidence (70.34%) and mortality (69.2%) comparative to female incidence (30.92%) mortality (30.87%). www.nature.com/scientificreports/ ST use in adults Its already reported that smokeless tobacco (ST) use though prevalent in 127 countries worldwide; the highest rates of consumption and risk estimates for oral cancer is in South and Southeast Asia 31 . Global Adult Tobacco Survey India 2016-2017 (GATS 2, https ://www.who.int/tobac co/surve illan ce/surve y/gats/ GATS_India _2016-17_FactS heet.pdf?ua=1) attributed ST, alcohol use and smoking as leading risk factors for lip and oral cavity cancer in India.…”