Chewing tobacco contributed to an estimated 251,000 deaths worldwide in 2023, according to a new analysis in The Lancet Global Health, the most comprehensive assessment of its harm ever conducted.

About 90 per cent of the health burden was concentrated in just 10 countries, including India. South Asia alone accounted for 84 per cent of deaths, or about 210,000 lives.

The study, from the Institute for Health Metrics and Evaluation at the University of Washington, covered 204 countries over 1990-2023. It estimated 241 million people aged 15 and above used chewing tobacco in 2023, with use peaking among people aged 60 to 64.

Despite decades of tobacco control, the global prevalence of chewing tobacco has barely changed since 1990, even as smoking rates fell. Stroke and lip and oral cavity cancer made up much of the health loss.

The findings point to a prevention gap: chewing products have largely escaped the taxation, ad bans and awareness campaigns that reshaped cigarette use.