New Delhi, Sept. 9 -- India accounted for 444 million of the estimated 2.71 billion people exposed to second-hand smoke worldwide in 2023, making it the second-most affected country after China, according to a new analysis of the Global Burden of Disease (GBD) 2023 study published in The Lancet Public Health. China had 654 million people exposed to second-hand smoke, while Indonesia ranked third with 142 million, the study found. Globally, second-hand smoke exposure was linked to 1.66 million deaths and 44.8 million disability-adjusted life-years (DALYs) --years of healthy life lost to illness, disability or premature death -- in 2023. Children accounted for more than 12% of the health burden. The study estimated that 33.9% of the global population was exposed to second-hand smoke in 2023. Although the proportion exposed fell 22% between 1990 and 2023, the absolute number remained almost unchanged because of population growth. Exposure rose sharply in sub-Saharan Africa and North Africa and the Middle East. Women and children bore a disproportionate burden. In Southeast Asia, East Asia and Oceania, women were 59% more likely than men to be exposed. Lower respiratory infections were the leading cause of second-hand smoke-related health loss among children, while ischaemic heart disease accounted for the largest overall burden, at 12 million DALYs. The exposure primarily comes from smoke released by burning tobacco products and smoke exhaled by smokers, exposing non-smokers at home, workplaces and public places. Children are vulnerable because of their developing airways and immune systems, the researchers said....