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Tobacco-attributable mortality and disease burden in India: a descriptive analysis of Global Burden of Disease 2023 estimates for 1990 and 2023

Year: 2026

Type: article

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.

Source: BMJ Open

DOI: 10.1136/bmjopen-2026-123483

Authors: Chaitali Mandal, Mayank Singh, Murali Dhar

Institutions: International Institute for Population Sciences, KLE Academy of Higher Education and Research

Language: English

Topic: Smoking Behavior and Cessation

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,839