Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 18;25(1):2818.
doi: 10.1186/s12889-025-23937-0.

Rural-urban disparities in tobacco use among middle aged and elderly Indian adults: a multivariate decomposition analysis

Pritam Halder #  1 , Anam Anil Alwani #  2 , Baridalyne Nongkynrih  3 , Soumya Chakraborty  4 , Anand Krishnan  3
Affiliations

Rural-urban disparities in tobacco use among middle aged and elderly Indian adults: a multivariate decomposition analysis

Pritam Halder et al. BMC Public Health. .

Abstract

Background: Globally, rural areas have a higher prevalence of tobacco consumption compared to urban areas. The reasons for this are poorly known but include individual, demographic, socio-economic, cultural and environmental factors. Among middle aged and elderly individuals in India, we estimated the rural-urban disparities in current smoked and smokeless tobacco use and conducted a decomposition analysis to identify the underlying determinates that contributed to the disparities.

Methods: Data from Longitudinal Ageing Study in India, wave 1 (2017-18) of adults aged more than 45 years was utilised in this analysis. The weighted prevalence of current tobacco use was estimated. Inequalities in tobacco consumption were disaggregated as per wealth index using the concentration index. Multivariate decomposition analysis was conducted to determine the extent to which different determinants of tobacco use (explanatory variables) contributed to rural-urban disparities in tobacco consumption (outcome variable). p < 0.05 was considered significant.

Results: The weighted prevalence of smoked tobacco use was 13.10% (95% CI: 9.35-18.05%) across India with a rural-urban absolute difference of 7.32%. The weighted prevalence of smokeless tobacco use was 20.43% (95% CI: 15.75-26.06%) with a rural-urban absolute difference of 10.79%. Smoked and smokeless tobacco consumption was concentrated among the poor with concentration indices of -0.01 and -0.07 respectively. Differences in the distribution of the determinants accounted for 59.36% of the difference in smoked tobacco consumption and 57.82% of the difference in smokeless tobacco consumption in rural and urban areas. For smoked tobacco, differences in educational status (41.30%), gender (7.25%) and caste (6.04%) were key contributors to the difference, while for smokeless tobacco, region of domicile (22.17%), educational status (20.08%) and occupational status (9.28%) contributed the most.

Conclusion: Tobacco use was found to be more prevalent in rural than urban areas and among the poorer wealth quintiles. Differences in the prevalence of various socio-economic and cultural factors were found to contribute to the rural-urban differences in tobacco consumption.

Keywords: Decomposition analysis; Disparities; Elderly; LASI; Middle aged; Rural; Smokeless tobacco; Smoking; Tobacco; Urban.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Indian Council of Medical Research (ICMR)’s Central Ethics Committee on Human Research (CECHR) granted ethical permission for the LASI survey. Since the present study involved a secondary analysis of the data from LASI, it did not require separate ethical approval. The LASI study was performed in line with the principles of the Declaration of Helsinki. The survey agencies that carried out the original field survey for data collection obtained prior informed consent (signed and oral) from eligible respondents as well as from the legal guardians of illiterate participants for biomarker testing and interviews. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Tobacco consumption among middle aged and elderly Indian adults as per wealth indices in India. A: Smoked tobacco; B: Smokeless tobacco p-value < 0.05
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, et al. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet. 2020;396(10258):1223–49. - PMC - PubMed
    1. Tamil Selvan S, Yeo XX, Van Der Eijk Y. Which countries are ready for a tobacco endgame? A scoping review and cluster analysis. Lancet Global Health. 2024;12(6):e1049–58. - PubMed
    1. Timberlake DS, Laitinen U, Kinnunen JM, Rimpela AH. Strategies and barriers to achieving the goal of Finland’s tobacco endgame. Tob Control. 2020;29:398–404. - PMC - PubMed
    1. Swasticharan L, Arora M, Sinha P, Ray C, Munish V, Shrivastav R. Report on tobacco control in India 2022 (Vol 22). Ministry of Health and Family Welfare, Government of India. Available from: https://ntcp.mohfw.gov.in/assets/document/surveys-reports-publications/.... Cited 30 Jun 2025.
    1. Gupta PC, Arora M, Sinha DN, Asma S, Parascandola M, editors. Smokeless tobacco and public health in India [Internet]. New Delhi: Ministry of Health & Family Welfare, Government of India; 2016. Available from: https://ntcp.mohfw.gov.in/assets/document/surveys-reports-publications/S.... Cited 8 Dec 2024.

LinkOut - more resources