Exposure to second-hand tobacco smoke was linked to an estimated 325,600 deaths in India in 2023, marking an increase of nearly 50 per cent from 217,700 deaths recorded in 1990, according to a new study published in The Lancet Public Health.

The findings also show that while the proportion of India’s population exposed to second-hand smoke has declined over the years, the actual number of people affected has risen. An estimated 444 million people in India were exposed in 2023, compared with 375 million in 1990, an increase of about 18.4 per cent.

Deaths And Disease Burden Rise Over Three Decades

The increase in deaths associated with second-hand smoke was recorded among both men and women between 1990 and 2023. Deaths among women rose from 113,400 to 156,900, while the number among men increased from 104,300 to 168,700 during the same period.

Apart from deaths, exposure to second-hand smoke was responsible for an estimated 9.28 million disability-adjusted life years, or DALYs, in India in 2023. DALYs measure the loss of healthy years resulting from premature death, illness or disability.

The findings indicate that the burden of tobacco smoke exposure extends beyond mortality, with millions of years of healthy life lost to illnesses associated with inhaling smoke produced by other people’s tobacco use.

The study linked second-hand smoke exposure to several serious health conditions, including ischaemic heart disease, stroke, lung cancer, chronic obstructive pulmonary disease, breast cancer, type 2 diabetes, asthma and lower respiratory infections.

Doctors Highlight Risks To The Heart And Brain

Dr KK Talwar, Cardiologist and Chairman of PSRI Heart Institute, New Delhi, said exposure to tobacco smoke can damage the inner lining of blood vessels and contribute to conditions affecting the heart and brain.

“Passive smoking is as bad as active smoking. When you inhale nicotine, it affects the inner layer of the arteries that go to the brain and the heart. Because of the damage to the endothelium and inner layer of the vessel, there is inflammation and then a plaque forms, which can be a source of blockages that can cause a stroke,” he said.

He also highlighted concerns over strokes among younger people exposed to cigarette smoke.

“Heart stroke in young people has been on the rise in the last seven years by 2 per cent every year,” Talwar said.

Dr Udgeath Dhir, Director and Head of Cardio Thoracic Vascular Surgery at Fortis Memorial Research Institute, Gurugram, said people exposed to second-hand smoke face a greater risk of cardiovascular diseases.

“People exposed to second-hand smoking have a 20 to 25 per cent higher chance of cardiovascular death, heart attack, brain stroke and other related diseases than those who aren’t exposed to it,” he said.

He said tobacco smoke contains particulate matter and nicotine that can affect the heart and blood vessels.

“Smoke has particulate matter and nicotine, which can affect cardiovascular health, the heart and its arteries. Passive smoking can lead to chronic changes which can affect their neurodevelopment. It is specifically bad for pregnant women as they’re nurturing two lives,” Dhir added.

He also cautioned against treating smoking as a harmless social activity. “In society, it appears that smoking is a status symbol in different circles. However, one should remember that it is so harmful that it can even lead to sudden cardiac death, in some cases,” he said.

Respiratory Illnesses And Risks To Children

The health consequences of second-hand smoke exposure are not confined to the cardiovascular system. The study associated exposure with lung cancer, chronic obstructive pulmonary disease, asthma and lower respiratory infections.

Children accounted for a significant share of the health burden. Lower respiratory infections were the leading contributor to the disease burden linked to second-hand smoke exposure among children, according to the study.

Exposure in homes and other indoor settings can result in repeated contact with tobacco smoke. Developing lungs can also make children particularly vulnerable to respiratory illnesses and other health problems associated with such exposure.

Dr Praveen Bansal, Oncologist at Asian Hospital, Faridabad, said people should take steps to prevent others from inhaling cigarette smoke.

“People need to avoid sitting in front of someone when smoking because they’re inhaling all the smoke, which can create deposits in the lungs that also increase the chances of cancer,” he said.

Bansal said pregnant women and children should not be exposed to cigarette smoke and advised people to avoid smoking in crowded places.

India Had Second-Highest Number Of Exposed People Globally

India recorded the second-highest number of people exposed to second-hand smoke worldwide in 2023, behind China, according to the study.

China had an estimated 664 million people exposed to second-hand smoke, while India’s exposed population stood at approximately 444 million. Indonesia was also among the countries with the largest number of people exposed.

Together, China, India and Indonesia accounted for nearly half of the global population exposed to second-hand smoke in 2023.

Worldwide, an estimated 2.71 billion people were exposed to second-hand smoke during the year. The exposure was associated with approximately 1.66 million deaths and 44.8 million DALYs globally.

Exposure Rate Falls Even As Number Of People Affected Increases

One of the key findings for India was the contrast between the declining proportion of people exposed and the growing number of individuals affected.

India’s age-standardised exposure prevalence fell from 43.2 per cent in 1990 to 30.6 per cent in 2023. However, the absolute number of people exposed increased from 375 million to 444 million over the same period.

The findings show how population growth can result in a larger number of people being exposed even when the overall prevalence of exposure declines.

The study underscores the continuing public health burden associated with tobacco smoke exposure in India, where hundreds of thousands of deaths and millions of lost healthy years were linked to second-hand smoke in 2023.

The impact of tobacco use, the findings suggest, extends beyond those who smoke themselves, with children and pregnant women among those requiring particular protection from exposure.

As Dr Dhir put it, “One should, anyway, quit smoking at any point in time.”

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