Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 13, 194

Global Burden of Disease Due to Smokeless Tobacco Consumption in Adults: Analysis of Data From 113 Countries


Global Burden of Disease Due to Smokeless Tobacco Consumption in Adults: Analysis of Data From 113 Countries

Kamran Siddiqi et al. BMC Med.


Background: Smokeless tobacco is consumed in most countries in the world. In view of its widespread use and increasing awareness of the associated risks, there is a need for a detailed assessment of its impact on health. We present the first global estimates of the burden of disease due to consumption of smokeless tobacco by adults.

Methods: The burden attributable to smokeless tobacco use in adults was estimated as a proportion of the disability-adjusted life-years (DALYs) lost and deaths reported in the 2010 Global Burden of Disease study. We used the comparative risk assessment method, which evaluates changes in population health that result from modifying a population's exposure to a risk factor. Population exposure was extrapolated from country-specific prevalence of smokeless tobacco consumption, and changes in population health were estimated using disease-specific risk estimates (relative risks/odds ratios) associated with it. Country-specific prevalence estimates were obtained through systematically searching for all relevant studies. Disease-specific risks were estimated by conducting systematic reviews and meta-analyses based on epidemiological studies.

Results: We found adult smokeless tobacco consumption figures for 115 countries and estimated burden of disease figures for 113 of these countries. Our estimates indicate that in 2010, smokeless tobacco use led to 1.7 million DALYs lost and 62,283 deaths due to cancers of mouth, pharynx and oesophagus and, based on data from the benchmark 52 country INTERHEART study, 4.7 million DALYs lost and 204,309 deaths from ischaemic heart disease. Over 85 % of this burden was in South-East Asia.

Conclusions: Smokeless tobacco results in considerable, potentially preventable, global morbidity and mortality from cancer; estimates in relation to ischaemic heart disease need to be interpreted with more caution, but nonetheless suggest that the likely burden of disease is also substantial. The World Health Organization needs to consider incorporating regulation of smokeless tobacco into its Framework Convention for Tobacco Control.


Fig. 1
Fig. 1
Smokeless tobacco prevalence among males and females
Fig. 2
Fig. 2
Random effects model showing relative risk for mouth cancer for smokeless tobacco use
Fig. 3
Fig. 3
Random effects model showing relative risk for pharyngeal cancer for smokeless tobacco use
Fig. 4
Fig. 4
Random effects model showing relative risk for oesophageal cancer for smokeless tobacco use
Fig. 5
Fig. 5
Random effects model showing relative risk for ischaemic heart disease for smokeless tobacco use

Similar articles

See all similar articles

Cited by 40 articles

See all "Cited by" articles


    1. CDC. Smokeless Tobacco Fact Sheets. Prepared for the 3rd International Conference on Smokeless tobacco: advancing Science and Protecting Public Health. Stockholm, Sweden: National Cancer Institute, CDC and Prevention & Stockholm Centre of Public Health; 2002.
    1. SEARO . WHO: report on oral tobacco use and its implications in South East Asia. New Delhi: SEARO; 2004.
    1. Palipudi K, Rizwan SA, Sinha DN, Andes LJ, Amarchand R, Krishnan A, et al. Prevalence and sociodemographic determinants of tobacco use in four countries of the World Health Organization: South-East Asia region: findings from the Global Adult Tobacco Survey. Indian J Cancer. 2014;51:S24–32. - PubMed
    1. Boffetta P, Hecht S, Gray N, Gupta P, Straif K. Smokeless tobacco and cancer. Lancet Oncol. 2008;9:667–75. doi: 10.1016/S1470-2045(08)70173-6. - DOI - PubMed
    1. International Agency for Research on Cancer. Smokeless tobacco products. In: IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, vol. 89. Lyon, France: International Agency for Research on Cancer; 2008.

Publication types

MeSH terms