BACKGROUND: Smokeless tobacco (SLT) is most widely consumed form of tobacco in India, with every fifth Indian adults (21.4%) being active user. However, its use is associated with severe health consequences, including oral and esophageal cancers, and cardiovascular diseases. Despite its significant public health impact, there is a paucity of nationally representative estimates of deaths and disability-adjusted life years (DALYs) and prematurely lost life years (YLLs) attributable to SLT consumption in the country. This study aimed to provide empirical estimates of the mortality and morbidity burden due to SLT consumption at both national and subnational levels in India.
METHODS: A meta-analysis of existing literature across India was conducted using secondary data from the Global Burden of Disease (GBD) 2021 database and primary data on SLT consumption patterns gathered from national health surveys. Population Attributable Fraction (PAF) was calculated based on the prevalence of SLT use and its relative risk for major SLT-related diseases, including cancers and cardiovascular conditions. The PAF values were applied to GBD data on total deaths and DALYs to estimate the absolute burden attributable to SLT consumption.
RESULTS: From 27 quantitative studies providing odds of disease occurrence, SLT consumption was estimated to be attributable for 171051 annual deaths, 4380540.62 DALYs and 4310922.51 YLLs in India. Subnational analysis revealed highest burden in states of Uttar Pradesh, Maharashtra and Tamil Nadu.

CONCLUSIONS: This study highlights the substantial health burden caused by SLT consumption in India. The findings emphasize the urgent need for strengthened regulatory measures, including higher taxation, pictorial warnings, and public awareness campaigns, to reduce SLT use. Tailored interventions focusing on high-burden states and vulnerable populations are critical to mitigating the adverse health impacts of SLT and achieving broader public health goals.