More than a quarter of a million people die each year from using smokeless tobacco, researchers at the University of York have concluded.
Millions more have their lives shortened by ill health due to the effects of chewing tobacco-based products, the study reveals.
Researchers say it is the first time the global impact of smokeless tobacco consumption on adults has been assessed.
The team, which included collaboration from the University of Edinburgh and Imperial College, London, says governments and public health bodies need to consider incorporating the regulation of smokeless tobacco into policy frameworks.
Dr Kamran Siddiqi, senior lecturer in epidemiology and public health at the Department of Health Sciences/Hull York Medical School, said: "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."
The study, which was funded by Leeds City Council and the Medical Research Council, estimates that in 2010 alone smokeless tobacco resulted in more than 62,000 deaths due to cancers of the mouth, pharynx and esophagus and accounted for more than 200,00 deaths from heart disease.
Researchers compiled the figures using data from 113 countries and extracted from the 2010 Global Burden of Disease Study and surveys such as Global Adult Tobacco Survey. The results are published in BMC Medicine.
The team says that more research is needed in countries with high levels of consumption but where figures for the relative risk of acquiring smoking-related cancers are not available.
Dr Siddiqi said South-East Asia was a hotspot and in particular India which accounts for 74 per cent of the global disease burden.
He added: "Smokeless tobacco is used by almost a quarter of tobacco users and most of them live in South-East Asia. But even in this country there are communities in east London, Leicester, Birmingham, Leeds, Bradford and Birmingham using it.
"We have got no international policy on how to regulate the production, composition, sale, labelling, packaging and marketing of smokeless tobacco products.
"The international framework to control tobacco doesn't seem to work to control smokeless tobacco. It doesn't get the same regulation as cigarettes.
"There is a need to build on the insights obtained from efforts to reduce cigarette smoking and to investigate strategies to reduce the use of smokeless tobacco."
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