Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019
Parkes J Kendrick, Marissa B Reitsma, Mohsen Abbasi-Kangevari, Amir Abdoli, Mohammad Abdollahi, Aidin Abedi, E S Abhilash, Victor Aboyans, Oladimeji M Adebayo, Shailesh M Advani, Bright Opoku Ahinkorah, Sohail Ahmad, Keivan Ahmadi, Haroon Ahmed, Budi Aji, Yonas Akalu, Chisom Joyqueenet Akunna, Fares Alahdab, Ziyad Al-Aly, Fahad Mashhour Alanezi, Turki M Alanzi, Khalid F Alhabib, Tilahun Ali, Sheikh Mohammad Alif, Vahid Alipour, Syed Mohamed Aljunid, Mahmoud A Alomari, Tarek Tawfik Amin, Saeed Amini, Hubert Amu, Robert Ancuceanu, Jason A Anderson, Catalina Liliana Andrei, Tudorel Andrei, Alireza Ansari-Moghaddam, Benny Antony, Davood Anvari, Jalal Arabloo, Nicholas D Arian, Monika Arora, Kurnia Dwi Artanti, Wondwossen Niguse Asmare, Desta Debalkie Atnafu, Marcel Ausloos, Asma Tahir Awan, Getinet Ayano, Getie Lake Aynalem, Samad Azari, Darshan B B, Ashish D Badiye, Atif Amin Baig, Maciej Banach, Srikanta K Banerjee, Suzanne Lyn Barker-Collo, Till Winfried Bärnighausen, Hiba Jawdat Barqawi, Sanjay Basu, Mohsen Bayati, Shahrzad Bazargan-Hejazi, Tariku Tesfaye Bekuma, Derrick A Bennett, Isabela M Bensenor, Habib Benzian, Catherine P Benziger, Adam E Berman, Akshaya Srikanth Bhagavathula, Neeraj Bhala, Nikha Bhardwaj, Pankaj Bhardwaj, Krittika Bhattacharyya, Sadia Bibi, Ali Bijani, Antonio Biondi, Dejana Braithwaite, Hermann Brenner, Andre R Brunoni, Katrin Burkart, Sharath Burugina Nagaraja, Zahid A Butt, Florentino Luciano Caetano dos Santos, Josip Car, Giulia Carreras, Joao Mauricio Castaldelli-Maia, Maria Sofia Sofia Cattaruzza, Jung-Chen Chang, Pankaj Chaturvedi, Simiao Chen, Onyema greg Chido-Amajuoyi, Dinh-Toi Chu, Sheng-Chia Chung, Liliana G Ciobanu, Vera Marisa Costa, Rosa A S Couto, Baye Dagnew, Xiaochen Dai, Albertino Antonio Moura Damasceno, Giovanni Damiani, Lalit Dandona, Rakhi Dandona, Parnaz Daneshpajouhnejad
Abstract
BACKGROUND: Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. METHODS: We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. FINDINGS: In 2019, 273·9 million (95% uncertainty interval 258·5 to 290·9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4·72% (4·46 to 5·01). 228·2 million (213·6 to 244·7; 83·29% [82·15 to 84·42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age-standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1·21% [-1·26 to -1·16]), similar progress was not observed for chewing tobacco (0·46% [0·13 to 0·79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0·94% [-1·72 to -0·14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. INTERPRETATION: Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. FUNDING: Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.