In Northeast India, older adults who have used tobacco or alcohol show striking associations with chronic diseases—including a nearly twenty-fold higher odds of cancer for people with past smoking behaviour. But this is an association, not proof of causation.

The North-eastern region of India has a relatively higher prevalence of substance use, which together with poor dietary practices and a lack of physical activity is one of the key risk factors for non-communicable diseases among older adults in the region. Understanding the prevalence of non-communicable diseases and their relationship to substance use can help develop preventive strategies and sensitization in North-eastern India.

Epidemiological transition theory describes how the mortality and morbidity of a society change over time due to changes in social and economic conditions. It involves a shift from a predominance of communicable diseases as the leading causes of death to a predominance of non-communicable diseases, such as cardiovascular disease, cancer, and diabetes, typically associated with older age.

Population ageing demonstrates the shift in the age structure of a population over time due to fertility and mortality decline, characterized by an increase in the proportion of people aged 60 and over. India is going through unprecedented demographic changes: increased life expectancy and fertility decline have changed the age structure of India’s older adults population, which is rapidly growing and emerging as a serious source of concern for the government and policymakers.

The goal should not be limited only to adding an extra number of years but to age healthily, because as people age, their risk for developing non-communicable diseases increases and can lead to reduced quality of life. Unhealthy lifestyles, such as substance use, lack of physical activity, and unhealthy diets, can contribute to the development of non-communicable diseases and poor quality of life.

Substance use is defined as the consumption of any psychoactive substance, such as tobacco, alcohol, or drug, other than those for medical use. Previous literature found that substance consumption is one of the main factors for the burden of disease, disability, premature death, and non-communicable diseases among older adults.

No other study had attempted to link substance use to the occurrence of non-communicable diseases, so this study aimed to investigate tobacco and alcohol use among older adults in northeast India. Noncommunicable diseases include cardiovascular diseases, cancer, diabetes, chronic respiratory diseases and neurological or psychiatric diseases, affect forty-one million people annually, and account for seventy-one percent of all deaths globally.

More than fifteen million people between the ages of thirty and sixty-nine die due to an NCD every year. Low- and middle-income countries account for eighty-five percent of these premature deaths and seventy-seven percent of all noncommunicable disease deaths.

GATS estimates that two hundred sixty-six point eight million adults in India aged fifteen and older use tobacco in some way daily, accounting for twenty-eight point six percent of them. The North-eastern area of the country displays the highest prevalence among all the other states.

Adult alcohol per capita consumption in India climbed from two point four liters in two thousand five, to four point three liters in two thousand ten, and five point seven liters in two thousand sixteen. A few small-scale studies found that the prevalence of substance use is higher in the North-eastern states of India.

In a study of the Mishing tribe in Assam, more than sixty percent of the population used alcohol and tobacco. A national study showed that current tobacco usage among older adults with at least one chronic disease was significantly higher in the Northeast region, at forty-seven point six percent.

The North-eastern region has a lower overall prevalence of non-communicable diseases than other regions of the country, but cardiovascular disease and diabetes were high compared with the central regions. Previous literature examined substance use and its association with noncommunicable diseases among adults and youth aged fifteen to fifty-four, but not specifically among older adults in the North-eastern region.

The study includes people aged sixty and above because non-communicable diseases are most prevalent and common at these stages, and previous lifestyle behaviour affects disease occurrence. The study uses the Longitudinal Ageing Study in India wave one individual dataset to assess the prevalence and association of substance use and noncommunicable diseases among older adults in the North-eastern states of India.

In Wave one of LASI, seventy-two thousand two hundred fifty adults aged forty-five and older and their spouses were included, including thirty-one thousand four hundred sixty-four older adults aged sixty and older. The analysis used dichotomous indicators of substance use: ever smoking or using smokeless tobacco, ever consuming alcohol, currently consuming smokeless tobacco, currently consuming alcohol, and currently smoking.

Physical activity was categorized into five groups, from every day to hardly or never. Information on twelve self-reported chronic physical diseases and conditions was gathered, including hypertension, diabetes, cancer, chronic lung disease, chronic heart disease, stroke, arthritis, osteoporosis or other bone or joint diseases, neurological or psychiatric problems, hypercholesterolemia, thyroid disease, gastrointestinal problems, and chronic renal disease.

These conditions were coded as either yes or no and used in the study. Because the noncommunicable disease outcomes were binary, with only two categories—yes and no—binary logistic regression was used. Binary logistic regression identified significant relationships between ever-consumed substances and noncommunicable diseases after controlling for socioeconomic and demographic variables among older adults aged sixty and above.

The sample consisted of four thousand one hundred fifty-five individuals from the North-eastern states of India. The share of participants was highest in the sixty-to-sixty-nine age group, males made up fifty-two percent and females forty-eight percent, and seventy-six percent lived in rural areas.

Only eleven percent had completed ten or more years of education, and sixty-two percent were currently married. Figure one reports the state-wise prevalence of non-communicable diseases among adults aged sixty and above in North-Eastern India during twenty seventeen to eighteen.

The chart labels prevalence at forty-eight percent in Assam, thirty-nine point two eight in Meghalaya, forty-six point seven two in Manipur, forty-six point four eight in Mizoram, fifty-one point two five in Tripura, twenty-one point two nine in Nagaland, thirty-seven point four six in Arunachal Pradesh, and sixty-five point eight nine in Sikkim.

This matters because it shows how widely the reported burden varies across states. Sikkim has the highest share of older adults suffering from any non-communicable disease, at sixty-five point eight nine percent, followed by Tripura at fifty-one point two five percent.

Assam, Manipur, Mizoram, Meghalaya, Arunachal Pradesh, and Nagaland follow in that order, with Assam at forty-eight percent and Nagaland at twenty-one point two nine percent. Table one presents descriptive statistics for four thousand one hundred fifty-five people aged sixty and above in Northeast India, alongside a comparison group of thirty-one thousand eight hundred eighty-seven people across India.

It reports age, sex, residence, caste, religion, MPCE quintile, education, marital status, and work status using frequencies and percentages. The Northeast sample is seventy-five point sixty-nine percent rural, and its largest religious category is Christian at forty-six point seventy-nine percent, making the table important for interpreting how the study population is composed.

Table two shows the prevalence of non-communicable disease by background characteristics and by state for people aged sixty and above in the North-eastern states of India. Prevalence of all the noncommunicable diseases among urban people is higher than among rural people, except for cancer, which is more prevalent in rural areas.

Hypertension is the most prevalent disease among the listed noncommunicable diseases, followed by diabetes and then bone or joint disease. Table two reports the prevalence of nine non-communicable diseases, plus any NCD, among adults aged sixty and above in North-eastern India during twenty seventeen to eighteen, broken down by demographic and socioeconomic characteristics.

The total prevalence of any NCD is forty-six point three seven percent, while the table also shows variation by sex, residence, education, work status, and state—for example, urban residents are reported at sixty-one point four five percent and rural residents at forty-two point four five percent.

Hypertension, cancer, heart diseases, high cholesterol, bone or joint diseases, and neurological or psychiatric diseases were higher among older women than men. Figure two shows the percentage of adults aged sixty and above with different non-communicable diseases who report past tobacco consumption, with error bars indicating uncertainty around each estimate.

The reported percentages are forty-seven point nine four for hypertension, forty-two point two one for diabetes, fifty-six point five two for cancer, sixty-nine point four nine for lung diseases, fifty-one point eight two for heart disease, thirty-six point three six for high cholesterol, fifty-four point zero eight for stroke, forty-seven point six seven for bone or joint disease, and sixty-three point seven seven for neurological or psychiatric disease.

Figure three reports the percentage of adults aged sixty and above with each noncommunicable disease who had ever consumed alcohol, with error bars showing uncertainty around each estimate. The reported percentages are twenty-one point zero six for hypertension, twenty-two point six one for diabetes, seventeen point three nine for cancer, twenty-seven point one two for lung diseases, eighteen point eighteen for heart disease, twenty point four five for high cholesterol, thirty-six point seventy-three for stroke, nineteen point seventy-one for bone or joint disease, and eighteen point eighty-four for neurological or psychiatric disease.

Table three shows binary logistic regression results for noncommunicable diseases with ever smoking or using tobacco products, ever consuming alcohol, current smoking, current tobacco-product consumption, and current alcohol consumption. Table 3 reports adjusted binary logistic regression results linking substance-use behaviours with hypertension, diabetes, and cancer among adults aged sixty and above in North-eastern India.

The table gives odds ratios, p-values, and ninety-five percent confidence intervals; for example, ever-smoked tobacco use has an odds ratio of nineteen point seven nine nine for cancer, with a confidence interval from eighteen point eight one nine to twenty point eight three.

These estimates account for physical activity and socio-demographic and economic variables, showing how the reported associations were evaluated after adjustment. Ever consumption of alcohol is associated with one point three three times more risk of hypertension, two point one five times more risk of diabetes, one point one two times more risk of heart diseases, one point two one times more risk of bone or joint disease, one point seven times more risk of stroke, and one point four times more risk of neuropsychiatric diseases compared with individuals who have never consumed alcohol.

Ever-consumed smoking and tobacco consumption create two point three one and two point nine one times more risk of lung diseases and heart disease, respectively, compared with non-smokers. Smoking and tobacco consumption create two point three one and two point nine one times more risk of lung diseases and heart disease, respectively, compared with non-smokers.

The chances of having cancer are nineteen point eight times higher with past smoking behaviour, and neuro and psychiatric disease is three point five six times higher than among non-smokers. The odds of suffering from any non-communicable disease are one point two times higher if someone has ever smoked or consumed smokeless tobacco, and one point two three times higher if someone has ever consumed alcohol.

The results revealed an association between substance use and non-communicable diseases among older people in the North-eastern states of India. Smoking tobacco, consuming smokeless tobacco, and alcohol consumption were significantly related to poor health in this population.

Because only the first wave had been completed, the study acts as a cross-sectional study, and no causal relationship has been inferred. The study is based on self-reported chronic disease data and self-reported substance consumption, which can hamper the estimations. Only binary yes-or-no responses were available, so the study could not assess the quantity, frequency, and duration of smoking, substance use, and alcohol consumption.

The study links substance use with non-communicable diseases among older adults in Northeast India, while its cross-sectional, self-reported data limit causal conclusions. The practical message is to prioritize alcohol reduction, smoking cessation, and physical activity.