BACKGROUND: Indian cigarillos (bidi) are a low-cost alternative to cigarettes and treated as a cottage industry with lax taxation and regulations. It is often considered ‘safer’ than cigarettes due to their marketed herbal origins. As the existing mortality and morbidity data on bidi is largely fragmented, this study was conducted to generate empirical evidences on absolute number of death and disability at national and subnational levels as a result of bidi consumption in India.
METHODS: This hospital-based country-wide case-control survey was conducted to gather bidi consumption history from patients diagnosed with COPD, Hypertension, IHD and TB, visiting health care facilities across 11 Indian states representing all the zonal divisions of the country. Gathered consumption values were used to calculate Population Attributable Fraction, which were then applied to the total deaths and DALYs from Global Burden of Disease (GBD) database for aforementioned diseases to arrive at final estimates.
RESULTS: From a total of 1012 study participants, attributable fraction of bidi consumption amongst diseased individuals was estimated to be 0.35 for TB, 0.22 for IHD, 0.23 for COPD and 0.09 for Hypertension. Applying these values to the global burden of disease (GBD 2021) data provided an estimate of 757590 annual deaths and 20168489.73 annual loss of DALYs as a result of bidi consumption in India. States of Uttar Pradesh, Maharashtra, Gujarat and West Bengal alone borne nearly half (48.42%) of the national mortality burden.

CONCLUSIONS: The study provides novel estimates of deaths and DALYs attributable to bidi consumption in India at national and subnational levels. The findings underscore the significant health burden attributable to bidi smoking with disproportionate burden in certain states, highlighting urgent need for targeted interventions in high-burden regions, robust policy measures and stricter regulation of bidi industry to safeguarding public health from such preventable burden of disease.