Lancet estimate puts 251,000 chewing-tobacco deaths in 2023, most of them in South Asia

Chewing tobacco contributed to an estimated 251,000 deaths worldwide in 2023, according to a study published in The Lancet Global Health and reported on 1 October. The same analysis put the number of users at 241 million, with use highest among people aged 60 to 64. South Asia accounted for about 210,000 of the deaths, roughly 84 percent of the global total. In that region, 14.6 percent of people aged 15 and above chewed tobacco products in 2023.

The concentration is sharper than the regional share. Among men, more than 90 percent of the deaths and disability linked to chewing tobacco fell in ten countries, a list that includes India, Bangladesh, China, Pakistan and the United States. Among women, more than 90 percent of the burden fell in a group that includes India, Bangladesh, Pakistan, Indonesia, Myanmar and China. India appears on both lists. The Hindu, citing the study, noted that the figures reflect total deaths and disability, so a large country can account for a large share even when its rate is not the highest. That caveat matters for India. A big absolute number is not the same claim as the highest rate per user.

The diseases named are specific. Stroke, and cancer of the lip and oral cavity, made up much of the health loss the authors attributed to chewing tobacco. Those are different pathways. Oral cancer tracks direct contact with the product. Stroke tracks the vascular effects of nicotine and the other constituents, in a population that is often older. The age peak in use, 60 to 64, sits on top of the ages at which both stroke and oral cancer are already more common. The estimate is of deaths contributed to, not of deaths caused solely by the product in people with no other risk. Reading 251,000 as a pure toll overstates what this kind of comparative risk model can show. Reading it as zero, because other risks exist, understates it.

South Asia's 14.6 percent prevalence is the exposure behind the 210,000 deaths. Chewing forms, rather than cigarettes, dominate in parts of India, Bangladesh and Pakistan in a way they do not in most of Europe or Latin America. The US presence on the male list is a reminder that the product is not confined to one region. Smokeless tobacco in the United States is a smaller market with a long record in oral cancer epidemiology. Its appearance in a top-ten absolute burden list is consistent with a large population and a smaller rate, which is the same caution the authors attached to the country ranking.

The study does not, in the public summary, rank Indian states or name the share of the 251,000 that is India's alone. India is grouped with the ten-country set. A state-level split would change the practical reading, because chewing rates in Maharashtra are not the rates in the northeast, and the product mix differs. What the national figure supports is a claim about where the global burden sits, not a claim about which district clinic will see the next case. Health departments that already run oral-cancer screening will find the 60-to-64 age peak more useful than the global total. That is the decade in which use is highest, and it is a decade in which screening programmes often have their weakest coverage.

The number to carry out of the paper is the pair, not the headline alone. 241 million users. 251,000 deaths attributed in 2023. 210,000 of them in South Asia. A 90 percent concentration, for men and for women, in a short list of countries that overlaps on India, Bangladesh, Pakistan and China. The open question the study leaves for Indian health accounts is the country's own share of the 210,000. Until that split is published, India is inside the epicentre the authors describe, without a separate national toll attached.