BACKGROUND: Tobacco consumption is a recognized global health concern with 8.7 million premature annual deaths. Recently, the consumption trends have undergone a significant shift from high-income countries to low and middle-income nations. Within this complex landscape, India grapples with a distinct challenge having nearly a quarter of its population being active tobacco users. This study quantifies the national and subnational potential economic productivity losses due to cigarettes, bidi and smokeless tobacco in India.
METHODS: Pooled odds and population attributable fraction were obtained through a meta-analysis of published studies concerning disease occurrence due to cigarette, bidi and SLT consumption in India. PAF values were applied to the total state disease burden for estimating DALYs attributable to cigarettes, bidis and SLT consumption. Obtained DALY values were then multiplied with the state GDP-per-capita to obtain the potential productivity losses to the individual Indian states and UTs.
RESULTS: From meta-analysis of 33 studies, a total loss of 8490585.43 annual DALYs was estimated due to cigarettes, 11838161.02 DALYs from bidis, and 4200646.46 DALYs from smokeless tobacco use in India. At the Indian GDP per capita of 2100 USD, an estimated annual potential productivity loss of USD 21056651858.33 results from cigarette consumption, USD 29358639332.37 from bidi consumption and USD 10417603230.38 from SLT consumption, equivalent to 2.15% of the annual national GDP. Highest state-wise burden was observed from Bihar (4.34%), Uttar Pradesh (3.98%) and Madhya Pradesh (2.90%).

CONCLUSIONS: Besides being a health hazard, tobacco also has huge economic ramifications. Our findings complement the existing work in tobacco control by quantifying the economic implications due to lost productivity, from a parallel lens of potential GDP losses amounting to 2.15% of the annual national GDP. The study also reports sub-national estimates which may be utilized for regional as well as country specific policy reforms.