Tobacco-attributable mortality and disease burden in India: a descriptive analysis of Global Burden of Disease 2023 estimates for 1990 and 2023
- 1Department of Bio-Statistics and Epidemiology, International Institute for Population Sciences, Mumbai, Maharashtra, India
- 2Department of Biostatistics and Health Data Science, KLE Academy of Higher Education and Research Deemed to be University, Belagavi, Karnataka, India
Abstract
Objectives: Tobacco use remains a major contributor to mortality and disability in India. This study assessed tobacco-attributable mortality and disability-adjusted life-years (DALYs) in India in 1990 and 2023, with comparisons by sex, age group and type of tobacco exposure.
Design: Descriptive population-level analysis of secondary data from the Global Burden of Disease 2023 study.
Setting: India.
Methods: Tobacco-attributable deaths and DALYs were assessed by sex, age group and type of tobacco exposure, including smoking, chewing tobacco and secondhand smoke. Absolute numbers and age-standardised rates were compared between 1990 and 2023.
Results: Tobacco-attributable deaths increased by 54.7%, from 745.74 thousand in 1990 to 1 153.98 thousand in 2023, while DALYs increased by 15.1%, from 27.3 to 31.4 million. In contrast, age-standardised death and DALY rates declined by 39.8% and 47.8%, respectively. Smoking remained the leading contributor (738.8 thousand deaths; 19.78 million DALYs in 2023), particularly among males. Chewing tobacco showed the largest increase (deaths +153.7%; DALYs +124.8%). Secondhand smoke remained substantial, particularly among females (325.63 thousand deaths), though its DALY burden declined by 10.8%. The burden shifted towards non-communicable diseases, with chronic obstructive pulmonary disease, ischaemic heart disease and stroke as leading contributors in 2023.
Conclusion: Despite declines in age-standardised rates, the overall burden of tobacco in India remains substantial. The differing patterns across smoking, chewing tobacco and secondhand smoke highlight the need for comprehensive and targeted tobacco-control strategies.
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BibTeX
@article{mandal2026tobaccoattributable,
title = {{Tobacco-attributable mortality and disease burden in India: a descriptive analysis of Global Burden of Disease 2023 estimates for 1990 and 2023}},
author = {Chaitali Mandal and Mayank Singh and Murali Dhar},
journal = {BMJ Open},
year = {2026},
month = sep,
doi = {10.1136/bmjopen-2026-123483},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-123483},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Tobacco-attributable mortality and disease burden in India: a descriptive analysis of Global Burden of Disease 2023 estimates for 1990 and 2023
AU - Chaitali Mandal
AU - Mayank Singh
AU - Murali Dhar
PY - 2026
DA - 2026/09/30
JO - BMJ Open
DO - 10.1136/bmjopen-2026-123483
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-123483
AB - Objectives: Tobacco use remains a major contributor to mortality and disability in India. This study assessed tobacco-attributable mortality and disability-adjusted life-years (DALYs) in India in 1990 and 2023, with comparisons by sex, age group and type of tobacco exposure. Design: Descriptive population-level analysis of secondary data from the Global Burden of Disease 2023 study. Setting: India. Methods: Tobacco-attributable deaths and DALYs were assessed by sex, age group and type of tobacco exposure, including smoking, chewing tobacco and secondhand smoke. Absolute numbers and age-standardised rates were compared between 1990 and 2023. Results: Tobacco-attributable deaths increased by 54.7%, from 745.74 thousand in 1990 to 1 153.98 thousand in 2023, while DALYs increased by 15.1%, from 27.3 to 31.4 million. In contrast, age-standardised death and DALY rates declined by 39.8% and 47.8%, respectively. Smoking remained the leading contributor (738.8 thousand deaths; 19.78 million DALYs in 2023), particularly among males. Chewing tobacco showed the largest increase (deaths +153.7%; DALYs +124.8%). Secondhand smoke remained substantial, particularly among females (325.63 thousand deaths), though its DALY burden declined by 10.8%. The burden shifted towards non-communicable diseases, with chronic obstructive pulmonary disease, ischaemic heart disease and stroke as leading contributors in 2023. Conclusion: Despite declines in age-standardised rates, the overall burden of tobacco in India remains substantial. The differing patterns across smoking, chewing tobacco and secondhand smoke highlight the need for comprehensive and targeted tobacco-control strategies.
SN - 2044-6055
SN - 2044-6055
ER -