Chewing tobacco contributed to an estimated 251,000 deaths worldwide in 2023, according to a Global Burden of Disease study from the Institute for Health Metrics and Evaluation published September 30, 2026, in The Lancet Global Health. South Asia accounted for about 210,000 of those deaths, and global use has not meaningfully declined since 1990. Key Takeaways An estimated 241 million people aged 15 and older used chewing tobacco in 2023, a global prevalence of 3.9%. No country recorded a significant decrease in the number of chewing tobacco users between 1990 and 2023, while 24 countries saw significant increases. More than 90% of male chewing tobacco-related health loss occurred in 10 countries: India, Bangladesh, China, Pakistan, Myanmar, the United States, Nepal, Sri Lanka, the Philippines, and Madagascar. Health loss attributed to chewing tobacco rose 116% between 1990 and 2023, reaching 6.48 million disability-adjusted life-years. Chewing tobacco accounted for 17.3% of lip and oral cavity cancer health loss worldwide and 30.5% in South Asia. Palau recorded the highest age-standardized prevalence at 24.4%, followed by Bangladesh at 23.4% and Nepal at 17.5%. IHME Study Separates Chewing Tobacco From Broader Smokeless Categories The Institute for Health Metrics and Evaluation (IHME) study, part of the