Smoking accounts for one-fifth of male deaths in India / AP

India is in the grip of a catastrophic epidemic that will claim one million lives a year during the decade starting in 2010 – from smoking.

The scale of the deaths is much greater than had been expected because Indians start smoking later and smoke less on average than Western populations. But for reasons that are not fully understood, Asians appear to be more susceptible to the harmful effects of tobacco. Smoking accounts for one in five male deaths and one in 20 female deaths in India and on average cuts 20 years from the lives of those it kills.

The findings, from the first major study of the causes of death in the sub-continent, led to calls for tough new measures to curb the epidemic. Professor Amartya Sen, who won the Nobel Prize for Economics in 2001, said: "It is truly remarkable that one single factor, namely smoking, which is entirely preventable, accounts for nearly one in 10 of all deaths in India. The study brings out forcefully the need for immediate public action."

Researchers from Canada, the UK and India compared the smoking histories of 74,000 adults who had died with 78,000 living controls. The results are published in the New England Journal of Medicine.

Professor Sir Richard Peto, a co-author of the study and the world's leading authority on the link between tobacco and ill-health, said: "We were surprised by just how dangerous smoking was for Indian populations. Epidemiology cannot answer the question why but we know India already has high death rates from respiratory disease... Indians also unfortunately have high heart disease rates and if you stick smoking on top of that it is not a good thing."

Professor Peto said the findings had worrying implications for Asians living in Britain. "For the very large south Asian population in Britain, smoking may be even more dangerous than for Caucasians, because of the heart disease risk."