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Update on numbers of tobacco-attributable deaths by country in the South-East Asia region: implications for policy
  1. Jagdish Kaur1,
  2. Arvind Vashishta Rinkoo1,
  3. Sol Richardson2
  1. 1Tobacco Free Initiative, World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
  2. 2Vanke School of Public Health, Tsinghua University, Beijing, China
  1. Correspondence to Dr Sol Richardson, Vanke School of Public Health, Tsinghua University, Beijing, China; srichardson{at}


Background The WHO South-East Asia Region is home to around 33% of adult tobacco users. To inform tobacco control policy and practice, we conducted a study using the latest available data to update mortality attributable to overall tobacco use, including smoked tobacco, smokeless tobacco (SLT) and secondhand smoke (SHS) exposure, in the 11 countries of the Region.

Methods We estimated smoking, SLT use and SHS exposure using the latest available surveys for each country during 2016–2021, and then estimated all-cause and lung cancer-attributable annual deaths for each using the population-attributable fraction method. Finally, we estimated the annual total tobacco-attributable deaths including all three exposures using the multiplicative aggregation method.

Results We estimated the occurrence of 4 087 920 all-cause deaths and 105 279 lung cancer deaths annually attributable to tobacco use among the 11 countries investigated. India accounted for 63.9% of all-cause tobacco-attributable deaths.

Conclusions The high annual number of tobacco-attributable deaths in the Region highlights the need for accelerating progress in reducing tobacco use. Implementation of the WHO Framework Convention on Tobacco Control (FCTC) and MPOWER policy package needs prioritisation at the country level. Tobacco cessation services, supply-side measures and policies to counter tobacco industry interference should be strengthened. Further work is needed to monitor progress towards FCTC implementation and analyse the impacts of policies on tobacco-related outcomes, including attributable mortality and disease burden, to inform advocacy efforts.

  • Smoking Caused Disease
  • Secondhand smoke
  • Global health
  • Non-cigarette tobacco products
  • Public policy

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  • Contributors JK developed the study concept. SR and AVR conceptualised and conducted the analysis and wrote the first manuscript draft. JK provided critical inputs to subsequent manuscript drafts. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The opinions or views expressed in this article are solely those of the author(s) and do not express the views or opinions of the organisation to which the authors are affiliated.

  • Competing interests No, there are no competing interests.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.