Understanding Gender Gaps in Tobacco Consumption among Middle-Aged and Elderly Indians: Decomposition Analysis of LASI 2017–18

BACKGROUND: While India is among the top consumers of tobacco globally, research is mostly limited to younger age groups. The present study aims to estimate the distribution of gender disparities in tobacco consumption across states and union territories. Further, our objective was to estimate socioeconomic inequalities of tobacco consumption as per wealth index across gender, and to determine the contribution of different demographic, socioeconomic, health related and behavioural factors to the gender disparities in tobacco consumption. METHODS: We did a secondary analysis of the data from 66,606 participants aged ≥ 45 years who participated in the first wave of the Longitudinal Aging Study in India (LASI) between 2017 and 18. Weighted distribution of gender disparities in tobacco consumption was documented as per Indian states and union territories with spatial distribution by Indian map, categorised into low, medium and large. Socioeconomic disparities were documented using a concentration curve as per gender. Multivariate decomposition analysis was conducted to estimate the contribution of different demographic, socioeconomic, health-related and behavioural factors separately. P-value less than 0.05 was considered as statistically significant. RESULTS: About 36.78% of the participants were consuming any form of tobacco. The prevalence was higher among males (57.58%) than females (19.11%), and elderly (39.72%) than middle-aged (33.82%) participants. We observed gender disparity with male predominance across all Indian states and union territories, with wide sub-national variation. As per the wealth index, the prevalence of tobacco consumption was significantly inclined towards the poorest (concentration index (95% CI): -0.067 (-0.075 to -0.059)) which was higher among males (-0.096 (-0.108 to -0.083)). Multivariate decomposition results showed that differences in endowment (E)/ composition accounted for 18.49%, whereas effect/ coefficient (C) differences accounted for 81.51% of the gender difference. The differences were mainly contributed by concurrent alcohol consumption (21.90%), media exposure (-5.09%), age (-4.19%), and regional differences. CONCLUSIONS: Tobacco consumption among older adults in India remains high, with marked gender disparities and socioeconomic inequalities. The decomposition analysis showed that the majority of the gender gap was accounted for by differences in the effects of characteristics (coefficients) rather than their distribution (endowment/ composition), indicating that gendered behavioural and contextual factors play a substantial role. These findings highlight the need for gender-sensitive and equity-oriented public health strategies to address tobacco use among vulnerable groups, while recognizing that the observed relationships are associative in nature.