ArticleBMJ open2026
Tobacco-attributable mortality and disease burden in India: a descriptive analysis of Global Burden of Disease 2023 estimates for 1990 and 2023.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTobacco use remains a major contributor to mortality and disability in India. This study assessed tobacco-attributable mortality and disability-adjusted life-years (DALYs) in India in 1990 and 2023, with comparisons by sex, age group and type of tobacco exposure.
designDescriptive population-level analysis of secondary data from the Global Burden of Disease 2023 study.
settingIndia.
methodsTobacco-attributable deaths and DALYs were assessed by sex, age group and type of tobacco exposure, including smoking, chewing tobacco and secondhand smoke. Absolute numbers and age-standardised rates were compared between 1990 and 2023.
resultsTobacco-attributable deaths increased by 54.7%, from 745.74 thousand in 1990 to 1 153.98 thousand in 2023, while DALYs increased by 15.1%, from 27.3 to 31.4 million. In contrast, age-standardised death and DALY rates declined by 39.8% and 47.8%, respectively. Smoking remained the leading contributor (738.8 thousand deaths; 19.78 million DALYs in 2023), particularly among males. Chewing tobacco showed the largest increase (deaths +153.7%; DALYs +124.8%). Secondhand smoke remained substantial, particularly among females (325.63 thousand deaths), though its DALY burden declined by 10.8%. The burden shifted towards non-communicable diseases, with chronic obstructive pulmonary disease, ischaemic heart disease and stroke as leading contributors in 2023.
conclusionDespite declines in age-standardised rates, the overall burden of tobacco in India remains substantial. The differing patterns across smoking, chewing tobacco and secondhand smoke highlight the need for comprehensive and targeted tobacco-control strategies.
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