Discussion This study shows that the prevalence of tobacco consumption was signiﬁcantly greater among victims dying due to circula- tory and pulmonary diseases and malignancy compared with deaths due to other causes (Table 4, 5). Tobacco consumption of various types was three-fold greater among men compared with women (Table 1). Tobacco smoking and chewing was more commonly associated with decedents due to circula- tory and pulmonary diseases and cancers, than with smoking and chewing of tobacco, independently (Table 5). However chewing of tobacco was also independently associated with these deaths compared with other causes of death. Tobacco chewing was also a cause of cardiovascular death in the INTERHEART study (2006). According to Indian Council of Medical Research esti- mates, the annual estimated mortality due to tobacco-related diseases varies between 630,000 and one million. At any point of time, there are about 374,000 cancer patients, 1.89 million patients with coronary artery disease (CAD), and 4.8 million patients with chronic obstructive pulmonary disease, attributable to tobacco usage. Taking a conservative estimate of a two-fold risk of smokers developing CAD, the number of cases attributable to smoking would be nearly 1.3 million or 15% of the present CAD cases (Singh et al 1999; Shah 2005). Tobacco deaths in India The exact prevalence of tobacco consumption, particu- larly in relation to mortality, is not available from various parts of India (Gupta et al 1980; Peto et al 1994). Various methods of tobacco use such as cigarette, beedi, and hukka (water-pipe) smoking and tobacco chewing are common in different parts of India (Gupta et al 1980, 1984; Singh et al 1997a, 1997b, 1997c). The prevalence of smoking varies between 20%–58% as reported in different studies from India (Gupta et al 1980, 1984; Singh et al 1997a, 1997c). Smoking is least common among Indian women, but tobacco chew- ing is common among 10%–30% of women in India. The adverse effects of tobacco chewing on heart disease are not known, however, age adjusted mortality rates were higher (Gupta et al 1980). The risk associated with beedi smoking has been estimated to be similar to cigarette smoking in various studies (Gupta et al 1980, 1984; Singh et al 1997c). Tobacco chewing, beedi, and hukka smoking appears to be more common in rural populations, whereas cigarette smok- ing and chewing of ﬂavored tobacco are more common in the urban population of India (Singh et al 1997a, 1997b, 1997c; Jindal 2006a, 2006b). In one population study (Jindal 2006a) among 73,605 subjects, the prevalence of smoking was 28.5% (n = 10,756) in men and 2.1% (n = 740) in women. Beedi was the commonest form of smoking, more so in the rural areas. Increasing age, low socioeconomic status and Table 4 Incidence of tobacco consumption among decedents due to various noncommunicable diseases Cause of death Men (n = 1385) Women (n = 837) Total (n = 2222) n Tobacco No n Tobacco No n Tobacco users tobacco users tobacco users Circulatory diseases Stroke Heart attack Sudden cardiac death Valvular heart disease Inﬂammatory cardiac disease Total Malignant neoplasm Lung cancer Oral cancer Liver cancer Stomach cancer Breast cancer Uterus and Cervix cancer Ovary cancer Total Chronic bronchitis and asthma 115 137 25 105 24 406 Men 24 23 16 14 – – – 77 97 102 (88.7)* 110 (80.3)* 18 (72)* 10 (9.5) 8 (33.3) 248 (61.1)* 21 (87.5)* 19 (82.6)* 10 (62.5)* 9 (64.3)* – – – 59(76.6)* 13 (11.3) 27 (19.7) 7 (28) 95 (90.5) 16 (66.7) 158 (38.9) 3 (12.5) 4 (17.4) 6 (37.5) 5 (35.7) – – – 18 (23.4) 60 85 20 55 20 240 Women 12 11 10 8 7 4 2 54 33 (55.0)* 47 (55.3)* 11 (55)* 1 (1.8) 1 (5.0) 93 (38.8) 7 (58.3)* 7(63.6)* 5 (50.0) 5 (62.5)* 6 (85.7)* 2 (50.0) 2 (100.0) 34(63.0)* 27 (45.0) 38 (44.7) 9 (45) 54 (98.2) 19 (95.0) 147 (61.3) 5 (41.7) 4 (36.4) 5 (50.0) 3 (37.5) 1 (14.3) 2 (50.0) 0 (0.0) 20 (37.0) 175 222 45 160 44 646 Total 36 34 26 22 7 4 2 131 135 (77.1)* 157 (70.7)* 29 (64.4)* 11 (6.9) 9 (20.5) 341 (52.8) 28 (77.8)* 26 (76.5)* 15 (57.7)* 14 (63.6)* 6 (85.7)* 2 (50.0) 2 (100.0) 93 71.0)* Men (n = 92) Women (n = 65) Total (n = 162) 75(77.3)* 22 (22.7) 65 22(33.8) 43 (66.2) 162 97(59.9)* 65 (40.1) Note: P < 0.02; P values obtained by comparison of tobacco users and nontobacco users by Chi square test. International Journal of COPD 2007:2(2) No tobacco 40 (22.9) 65 (29.3) 16 (35.6) 149 (93.1) 35 (79.5) 305 (47.2) 8 (22.2) 8 (23.5) 11 (42.3) 8 (36.4) 1 (14.3) 2 (50.0) 0 (0.0) 38 (29.0) 181