Chinese men now smoke more than a third of the world's cigarettes, and 1 in 3 of all young men in China will eventually be killed by tobacco, according to new research published in The Lancet.Researchers from Oxford University in the UK, the Chinese Academy of Medical Sciences and the Chinese Centre for Disease Control have found that 2 in 3 young men in China smoke, mostly starting before age 20. Unless a significant number quit, about half the smokers will be killed by their habit.
Overall adult mortality rates in China are falling, but as the adult population grows, and with it the proportion of male deaths from smoking, the annual number of tobacco-related deaths is set to rise from about 1 million in 2010 to 2 million in 2030 and 3 million in 2050.
While tobacco smoking in western countries has decreased in recent decades, cigarettes are becoming increasingly popular among young Chinese men, and the consequences are now emerging.
20% of male deaths now caused by tobaccoThe researchers conducted two large, nationally representative studies 15 years apart, tracking the health consequences of smoking in a large group of people in China.
The first study, in the 1990s, involved 250,000 men; the second is ongoing, and involves 500,000 men and women.
The proportion of all male deaths at ages 40-79 that are caused by smoking has doubled, from about 10% in the early 1990s to about 20% now.
In cities the proportion is 25% and rising. It is currently lower in rural areas, but it is predicted to rise even more sharply than in urban areas, since many smoke and very few quit.
Among Chinese women, conversely, smoking rates have fallen dramatically, and the risk of premature death from tobacco is low and decreasing. Of women born since 1960, fewer than 1% of deaths are due to tobacco.
Nevertheless, a recent increase in smoking by adolescent females, thought to be due to social changes, could eventually reverse this downward trend.
On the positive side, a higher proportion of smokers are now choosing to quit, and the study shows that between 1991 and 2006, the proportion of smokers who had quit rose from 3% to 9%.
For smokers who stopped before developing any serious disease, after 10 years of not smoking, their risk was similar to that of people who had never smoked.
In terms of disease resulting from smoking, tobacco-related deaths in China are less likely to be from vascular disease, unlike in the US.
Rates of lung cancer have historically been three times higher than those in the US and commonly affected nonsmokers. This was due to indoor pollution from heating and cooking. Now, however, while nonsmokers die less frequently from lung cancer and respiratory diseases, smokers are more likely to do so.
Action needed to reduce smokingStudy coauthor Prof. Liming Li, from the Academy of Medical Sciences in Beijing, China, says: "Without rapid, committed, and widespread action to reduce smoking levels, China will face enormous numbers of premature deaths."
Coauthor Prof. Sir Richard Peto, from the University of Oxford, attributes the fall in smoking in western countries to the increase in price, and suggests that raising tobacco prices substantially in China could save tens of millions of lives.
China's 2030 sustainable development goals include reducing noncommunicable disease mortality by a third. Widespread smoking cessation, the report concludes, "would offer one of the most effective, and cost-effective strategies to avoid disability and premature death over the next few decades."
In a linked comment, Jeffrey Koplan, from Emory University in Atlanta, GA, and Michael Eriksen, from Georgia State University, write: