Tobacco usage among general Indian population: A meta-analysis of evidence drawn from regional studies between 2010 - 2022.

ObjectivesThe purpose of this review is to generate a national and zonal pooled estimate of Current Tobacco Usage (CTU) in any form, as well as stratified gender and tobacco type (smokeless & smoke) specific estimates among the general Indian population, utilizing evidence from 2010 to 2022. MethodPubMed, Scopus, Science Direct, CINAHL and Google Scholar databases were searched for articles on tobacco use among Indian adults published between January 2010 and October 2022. The NIH Quality Assessment Tool was used to assess study quality, and a random-effects inverse-variance method was used to attain a pooled estimate of usage. Heterogeneity was estimated through I2 statistics and prediction intervals, and further subgroup analysis and meta-regression were conducted. To estimate publication bias eggers test was performed and a leave-one-out analysis was done to establish the sensitivity of our overall pooled estimate. ResultsCTU of any form amongst the Indian population irrespective of age group was 35.25% (Confidence Interval (CI) 25.27 - 45.92, I2 = 99.7, P-value < 0.001) between the years 2010 - 2022, whereas through 2016 - 2022 regionally drawn estimate was 44.38% (CI 30.57 - 58.64, I2 = 99.8, P-value < 0.01). The region-wise highest prevalence was found in the East zone (55.43%) followed by North - East with 51.88% consumption. Though residual heterogeneity was present after subgroup analysis, Variability in estimates was statistically significant by administrative zones and gender-wise consumption (test of subgroup difference P value <0.0001). Leave-one-out analysis proved consistency in our overall CTU estimate. ConclusionThe differences between national-level surveys and regional estimates are highlighted in this review and thereby warrant more regionally representative surveys of tobacco usage for tailor-making prevention efforts alongside, increased regional efforts, improved community-level advocacy, and more coordinated and stringent tobacco prevention policy implementation at national and state levels.