Death, Disability, and Premature Life Years Lost Due to Cigarettes, Bidis, and Smokeless Tobacco in India: A Comparative Assessment

BACKGROUND: Due to the staggering number of tobacco users in India, it is important to determine the exact mortality and morbidity rates due to tobacco use. This study aimed to estimate deaths, disability-adjusted life years (DALYs), and years of life lost (YLLs) attributable to cigarettes, bidis, and smokeless tobacco (SLT) in India. METHODS: Data pooling and meta-analysis were done using case-control studies available on the three types of tobacco products. Health burden was estimated by applying the population attributable fraction (PAF) value to the total disease burden. FINDINGS: A total of 33 studies were included. PAF was calculated for oral and lung cancer as well as ischemic heart disease (IHD) due to cigarettes, oral and lung cancer, IHD, and chronic obstructive pulmonary disease due to bidi, and oral and stomach cancer and IHD due to SLT. Cigarettes resulted in 8.4 million DALYs, 8.26 million YLLs, and 341 deaths; bidis led to 11.7 million DALYs, 10.7 million YLLs, and 478 thousand deaths, and SLTs accounted for 4.38 million DALYs, 4.3 million YLLs, and 171 thousand deaths annually. CONCLUSION: Evidence of measurable health burden and methodology for calculation for individual states was provided in the study. The generated evidence could be utilized for policy recommendations and revision of the existing taxation norms.