The University of York team said its analysis of data from 113 countries and other sources is the first study to assess the international impact of smokeless tobacco on adults.

"It is possible that these figures are underestimated, and future studies may reveal that the impact is even bigger. We need a global effort to try and address and control smokeless tobacco," lead researcher Kamran Siddiqi, a senior lecturer in epidemiology and public health at York, said in a university news release.

The researchers estimated that in 2010 alone, smokeless tobacco caused more than 62,000 deaths due to cancers of the mouth, pharynx and esophagus, and more than 200,000 deaths from heart disease.

India is a particular hotspot, and accounts for 74 percent of smokeless tobacco-related disease worldwide, according to the study published online recently in the journal BMC Medicine.

"We have got no international policy on how to regulate the production, composition, sale, labeling, packaging and marketing of smokeless tobacco products," Siddiqi said.

"The international framework to control tobacco doesn't seem to work to control smokeless tobacco. It doesn't get the same regulation as cigarettes," he added.

But past efforts to curb cigarette smoking could inform the creation of policies to reduce the use of smokeless tobacco, Siddiqi concluded.