Associations between disability and tobacco use in 31 low-income and middle-income countries: a secondary analysis of cross-sectional data from Multiple Indicator Cluster Surveys
Abstract
Background: Globally, individuals with disabilities may experience disproportionate tobacco use burden, though evidence comes predominantly from high-income settings. A substantial knowledge gap persists regarding tobacco consumption patterns among populations with disability in low- and middle-income countries (LMICs). This study aimed to examine associations between disability and tobacco use across diverse LMIC contexts.
Methods: We conducted secondary analysis of cross-sectional data from the sixth round of UNICEF-supported Multiple Indicator Cluster Surveys (MICS), spanning 2017-2023 across 31 LMICs. Participants were adults aged 18-49 years in the MICS Adult Functioning module with valid survey weights (weight >0); we excluded respondents with non-positive weights. For pooled meta-analyses, we applied a prespecified minimum sample-size criterion (<25 smokers with disability), which did not exclude any country. Disability status was measured using the validated Washington Group Short Set criteria (WG-SS). Self-reported tobacco use behaviours constituted primary outcomes. Modified Poisson regression models estimated risk ratios (RR) adjusted for age, marital status, residence, education level, number of children, and wealth status with 95% confidence intervals (95% CI), stratified by country. Main analyses were stratified by sex to account for differential sampling frames between male and female respondents. Meta-analysis pooled country-specific estimates for an overall…
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