A study that assessed the global impact of smokeless tobacco consumption on adults reveals that more than a quarter of a million people in the world die each year from using smokeless tobacco, and India bears three-fourths of the burden.
Millions more have their lives shortened by ill-health due to the effects of chewing tobacco-based products, the findings showed.
Advertisement"Nearly 85 percent of the total burden attributable to smokeless tobacco (SLT) use was in South-East Asia, with India alone accounting for 74 percent of the global burden, followed by Bangladesh (five percent)," said the study.
Researchers compiled the figures using data from 113 countries and extracted from the 2010 Global Burden of Disease Study and surveys such as Global Adult Tobacco Survey.
In 2010 alone smokeless tobacco resulted in more than 62,000 deaths due to cancers of the mouth, pharynx and oesophagus and accounted for more than 200,000 deaths from heart disease, the study estimated.
"It is possible that these figures are underestimated and future studies may reveal that the impact is even bigger," said Kamran Siddiqi, senior lecturer in epidemiology and public health at University of York in England.
The team said that more research is needed in countries with high levels of consumption but where figures for the relative risk of acquiring smoking-related cancers are not available.
"We need a global effort to try and address and control smokeless tobacco," Siddiqi said.
"We have got no international policy on how to regulate the production, composition, sale, labelling, packaging and marketing of smokeless tobacco products," he pointed out.
The international framework to control tobacco does not seem to work to control smokeless tobacco. It does not get the same regulation as cigarettes, Siddiqi pointed out.
"There is a need to build on the insights obtained from efforts to reduce cigarette smoking and to investigate strategies to reduce the use of smokeless tobacco," he noted.
The results were published in the journal BMC Medicine.
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