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Tobacco Epidemic and Health Risk in the Chinese Population

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Tobacco Control in China

Abstract

The prevalence of tobacco in Chinese men has peaked since the 1980s. The past 30 years, the smokers start to smoking more and more early, and a half of smokers did before 20 years old in 2010 survey; the prevalence of male smoking only fallen about 10% from 1984 to 2015, did not drop and still over 50% from 2002 to 2015. For female, its prevalence of smoking has been kept very low level. By 2015, after 10 years the entry into force of the Convention, the prevalence of SHS exposure at homes and in the public places were dropped to 46.7 and 54.3%, separately. However, there are still about half of the non smokers at home or in public places suffer from SHS exposure. Reviewing eight case-control or prospective cohort studies in different urban and rural of China from 1980s to 2005. The overall mortality of smokers was significantly greater than that of nonsmokers, relative risk (RRs) are from 1.1 in 1990s rural to 1.65 in 2010 urban. The urban male smokers who had started before age 20 years had twice the never-smoker mortality rate (RR 1.98, 1.79–2.19) and who daily smoked more than 25 cigarettes was closed twice (RR 1.93, 1.75–2.12). Based on these estimation, smoking caused about one million (840,000 male, 130,000 female) deaths in China in 2010. The female tobacco attributable mortality fraction may be over-estimated from GBD2010 study and WHO 2008 study, which is different with the results of all epidemiological studies. GBD study estimated that exposure SHS causes around 159,000 deaths in China in 2010. Although it is need to further approach and deepen for the scientific evidence on secondhand smoke, the current global and Chinese evidences were sufficient for public health intervention.

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Notes

  1. 1.

    Smoking and health: report of the Advisory Committee to the Surgeon General of the Public Health Service. Washington, DC: Department of Health, Education, and Welfare, 1964:387. (PHS publication no. 1103).

  2. 2.

    US Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention, Office on Smoking and Health, 2004.

  3. 3.

    U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010.

  4. 4.

    U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

  5. 5.

    Chapter 3 Chemistry and Toxicology of Cigarette Smoke and Biomarkers of Exposure and Harm. In: U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010.

  6. 6.

    Lopez AD, Collishaw N, Piha T. A descriptive model of the cigarette epidemic in developed countries. Tob Control 1994;3:242e7.

  7. 7.

    Thun M, Peto R, Lopez AD et al. Stages of the cigarette epidemic on entering its second century, Tobacco Control 2012;21:96e101.

  8. 8.

    Majid Ezzati and Alan D. Lopez, Smoking and oral tobacco use, in Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors (Volume 1) Edited by Majid Ezzati, Alan D. Lopez, Anthony Rodgers and Christopher J.L. Murray.

  9. 9.

    Weng XZ, Hong ZG, Chen DY (1987) Smoking prevalence in Chinese aged 15 and above. Chin J (Engl) 100:886–892.

  10. 10.

    Yang GH, Fan LX, Tan J et al (1999) Smoking in China: findings of the 1996 national prevalence survey. JAMA 282:1247–1253.

  11. 11.

    Yang GH, Ma JM, Liu N, et al (2005) Smoking and passive smoking in Chinese, 2002, Zhong Hua Liu Xing Bing Xue Za Zhi 26:77–83.

  12. 12.

    2010 Li Q, Xia JS, Yang GH, Prevalence of Smoking in China in 2010 Nengl j med 364;25 nejm.org June 23, 2011.

  13. 13.

    Liang XF, ed. 2015 China Adult Tobacco Survey Report. China (Beijing): People’s Medical Publishing House. 2016 [in Chinese].

  14. 14.

    China CDC, 2015 report of tobacco survey for adults in China http://www.tcrc.org.cn/UploadFiles/2016-03/318/201603231215175500.pdf.

  15. 15.

    Chen Z M, Xu Z, Collins R, Li W X, Peto R (2007) Early health effects of the emerging tobacco epidemic in China. A 16-year prospective study. JAMA 1997 Nov 12; 278: 1500–1504.

  16. 16.

    Yuan JM, Ross RK, Wang XL, Gao YT, Henderson BE, Yu MC. Morbidity and mortality in relation to cigarette smoking in Shanghai, China. A prospective male cohort study. JAMA 1996; 275: 1646–50.

  17. 17.

    Lam TH, He Y, Li LS, Li LS, He SF, Liang BQ. Mortality attributable to smoking in China. JAMA 1997;278:1505–8.

  18. 18.

    Liu B Q, Peto R, Chen Z M, Boreham J, Wu Y P, et al. (1998) Emerging tobacco hazards in China: 1. retrospective proportional mortality study of one million deaths. BMJ 317: 1411–1422.

  19. 19.

    Gu D, Kelly T N, Wu X, Chen J, Samet J M, et al. (2009) Mortality attributable to smoking in China. N Engl J Med 360: 150–159.

  20. 20.

    Niu SR, Yang GH, Chen ZM, et al. Emerging tobacco hazards in China: 2. Early mortality results from a prospective study. BMJ 1998; 317: 1423–24.

  21. 21.

    Chen, ZM, Richard Peto, Maigeng Zhou, et al. Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies, Lancet 2015; 386: 1447–56.

  22. 22.

    Chen ZM, Chen J, Collins R, et al. China Kadoorie Biobank of 0.5 million people: survey methods, baseline characteristics and long-term follow-up. Int J Epidemiol 2011; 40: 1652–66.

  23. 23.

    Chen, ZM, Richard Peto, Maigeng Zhou, et al Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies, Lancet 2015; 386: 1447–56.

  24. 24.

    Chen ZM, Peto R, Lona A., et al. Emerging Tobacco-Related Cancer Risks in China: A Nationwide, Prospective Study of 0.5 Million Adults, Cancer 2015;121:3097–106.

  25. 25.

    Lam TH, Ho SY, Peto R. at el. Mortality and smoking in Hong Kong: case-control study of all adult deaths in 1998. BMJ 2001; 323: 361.

  26. 26.

    Zheng W, McLerran DF, Rolland BA, et al. Burden of Total and Cause-Specific Mortality Related to Tobacco Smoking among Adults Aged >=45 Years in Asia: A Pooled Analysis of 21 Cohorts, PLOS Medicine, e1001631 April 2014, Volume 11.

  27. 27.

    US Department of Health and Human Services, (1989) Reducing the health consequences of smoking: 25 years of progress. A report of the Surgeon General. DHHS Publication No. CDC 89–8411. Rockville (Maryland): US Department of Health and Human Services.

  28. 28.

    IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, (2004) Tobacco smoke and involuntary smoking. IARC Monogr Eval Carcinog Risks Hum 8: 1–1438.

  29. 29.

    Pirie K, Peto R, Reeves G K, Green J, Beral V, et al. (2013) The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Lancet 381: 133–141.

  30. 30.

    Doll R, Peto R , Wheatley K, Gray R, Sutherland I (1994) Mortality in relation to smoking: 40 years’ observations on male British doctors. BMJ 309: 901–911.

  31. 31.

    Thun M J, Carter B D, Feskanich D , Freedman N D, Prentice R, et al. (2013) 50-year trends in smoking-related mortality in the United States. N Engl J Med 368: 351–364.

  32. 32.

    Chen ZM Peto R Zhou MG et al Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies Lancet 2015; 386: 1447–56.

  33. 33.

    China CDC Global Adult Tobacco Survey (GATS) China 2010 Country Report, edited by Yang GH, China San Xia Press, 2011 Nov.

  34. 34.

    U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

  35. 35.

    Rockhill B, Newman B and Weinberg C, Use and Misuse of Population Attributable Fractions, American Journal of Public Health, January 1998, Vol. 88, No. 1 15–19.

  36. 36.

    U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. P650.

  37. 37.

    Doll R, Peto R. Cigarette smoking and bronchial carcinoma: dose and time relationships among regular smokers and lifelong non-smokers. J Epidemiol Community Health 1978; 32: 303–13.

  38. 38.

    Freund KM, Belanger AJ, D’Agostino RB, Kannel WB. The health risks of smoking. The Framingham Study: 34 years of follow-up. Ann Epidemiol 1993; 3: 417–24.

  39. 39.

    Naohito Yamaguchi Yumiko Mochizuki-Kobayashi Osamu Utsunomiya, Quantitative relationship between cumulative cigarette consumption and lung cancer mortality in Japan, International Journal of Epidemiology, 2000 29(6), 963–968.

  40. 40.

    Peto R, Lopez AD, Boreham J, et al Mortality from in developed countries: indirect estimation from national vital statistics, Lancet 1986, 339:1268–78.

  41. 41.

    Smith KR, Shuhua G, Kun H, et al. One hundred million improved cookstoves in China: how was it done? World Development 1993;21:941–61.

  42. 42.

    Du YX, Cha Q, Chen XW, et al. An epidemiological study of risk factors for lung cancer in Guangzhou, China. Lung Cancer 1996;14:S9–37.

  43. 43.

    He XZ, Chen W, Liu ZY, Chapman RS (1991) An epidemiological study of lung cancer in Xuan Wei county, China: current progress. Case-control study on lung cancer and cooking fuel. Environmental Health Perspectives, 94:9–13.

  44. 44.

    Wang TJ, Zhou BS, Shi JP (1996) Lung cancer in nonsmoking Chinese women: a case control study. Lung Cancer, 14:S93–98.

  45. 45.

    Liu BQ. 1990 Retrospective proportional mortality study of one million deaths to estimate tobacco attributable mortality in China, BMJ 1998;317:1411–22.

  46. 46.

    Majid Ezzati and Alan D. Lopez, Chapter 11 Smoking and oral tobacco use, in Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors edited by EzzatiM, Lopez AD, Rodgers A and Christopher J.L. Murray.

  47. 47.

    Majid Ezzati and Alan D. Lopez, Table 11.2 and 11.3 from Smoking and oral tobacco use, in Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors (Volume 1) Edited by Majid Ezzati, Alan D. Lopez, Anthony Rodgers and Christopher J.L. Murray.

  48. 48.

    Liu BQ. 1990 Retrospective proportional mortality study of one million deaths to estimate tobacco attributable mortality in China, BMJ 1998;317:1411–22.

  49. 49.

    Jee SH, Suh I, Kim IS, Appel LJ (1999) Smoking and atherosclerotic cardiovascular disease in men with low levels of serum cholesterol: the Korea Medical Insurance Corporation study. Journal of the American Medical Association, 282:2149–2155.

  50. 50.

    Stephen S Lim‡, Theo Vos, Christopher J L Murray†, et al, A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010, Lancet 2012; 380: 2224–60.

  51. 51.

    Liu BQ. 1990 Retrospective proportional mortality study of one million deaths to estimate tobacco attributable mortality in China.

  52. 52.

    Thun MJ, Hannan LM, Adams-Campbell LL, et al. (2008) Lung Cancer Occurrence in Never-Smokers: An Analysis of 13 Cohorts and 22 Cancer Registry Studies. PLOS Medicine 5(9): e185. https://doi.org/10.1371/journal.pmed.0050185.

  53. 53.

    Wang L, Wang LJ, Zhou MG et al Analysis of under-reporting of mortality surveillance from 2006 to 2008. Chin. J Prov. Med. 45(12) Dec. 2011, 1061–4.

  54. 54.

    Chen GB, Huang HC, Yang GH, et al Investigation on under-reported deaths in Xuan Wei, Yunnan Province during 2011-2013. Chin. J Prov. Med. 49(6) 541–5.

  55. 55.

    Majid Ezzati and Alan D. Lopez, Chapter 11 Smoking and oral tobacco use, in Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors edited by Ezzati M, Lopez AD, Rodgers A and Christopher J.L. Murray.

  56. 56.

    Ezzati M, Lopez AD. Measuring the accumulated hazards of smoking: global and regional estimates for 2000, Tobacco Control 2003;12:79–85.

  57. 57.

    M Ezzati, A D Lopez, Measuring the accumulated hazards of smoking: global and regional estimates for 2000, Tobacco Control 2003;12:79–85.

  58. 58.

    Majid Ezzati and Alan D. Lopez, Smoking and oral tobacco use, in Comparative Quantification of Health Risks Global and Regional Burden of Disease Attributable to Selected Major Risk Factors (Volume 1) Edited by Majid Ezzati, Alan D. Lopez, Anthony Rodgers and Christopher J.L. Murray.

  59. 59.

    World Health Organization, WHO Global report: Mortality Attributable to Tobacco, 100–101.

  60. 60.

    Ezzati M, Lopez AD Measuring the accumulated hazards of smoking: global and regional estimates for 2000, Tobacco Control 2003;12:79–85.

  61. 61.

    Jaakkola MS, Jaakkola JJ. Assessment of exposure to environmental tobacco smoke. European Respiratory Journal 1997;10(10):2384–97.

  62. 62.

    Jaakkola MS, Samet JM. Environmental tobacco smoke: risk assessment. Environmental Health Perspectives 1999;107(Suppl 6):823–904.

  63. 63.

    Hirayama T. Cancer mortality in nonsmoking women with smoking husbands based on a large scale cohort study in Japan. Preventive Medicine 1984;13(6):680–90.

  64. 64.

    Pron GE, Burch JD, Howe GR, Miller AB. The reliability of passive smoking histories reported in a case-control study of lung cancer. American Journal of Epidemiology 1988;127(2):267–73.

  65. 65.

    Coultas DB, Peake GT, Samet JM. Questionnaire assessment of lifetime and recent exposure to environmental tobacco smoke. American Journal of Epidemiology 1989;130(2):338–47.

  66. 66.

    Emerson JA, Hovell MF, Meltzer SB, Zakarian JM, Hofstetter CR, Wahlgren DR, Leaderer BP, Meltzer EO. The accuracy of environmental tobacco smoke exposure measures among asthmatic children. Journal of Clinical Epidemiology. 1995;48(10):1251–9.

  67. 67.

    National Research Council. Human Exposure Assessment for Airborne Pollutants: Advances and Opportunities. Washington: National Academy Press, 1991.

  68. 68.

    Klepeis NE. An introduction to the indirect exposure assessment approach: modeling human exposure using micro-environmental measurements and the recent National Human Activity Pattern Survey. Environmental Health Perspectives 1999;107(Suppl 2):365–74.

  69. 69.

    Liu R., Jiang Y., Li Q. et al An Assessment of Health Risks and Mortality from Exposure to Secondhand Smoke in Chinese Restaurants and Bars. PLOS ONE, Volume 9 Issue 1, e84811, 2014, January.

  70. 70.

    Hirayama T. Cancer mortality in nonsmoking women with smoking husbands based on a large scale cohort study in Japan. Preventive Medicine 1984;13(6):680–90.

  71. 71.

    Trichopoulos D, Kalandidi A, Sparros L. Lung cancer and passive smoking: conclusion of Greek study [letter]. Lancet 1983;2(8351):677–8.

  72. 72.

    U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.

  73. 73.

    U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006. Chapter 7.

  74. 74.

    Oono IP, Mackay DF, Pell JP. Meta-analysis of the association between secondhand smoke exposure and stroke. J Public Health (Oxf) 2011; 33: 496–502. 21 March 2011.

  75. 75.

    Yin P, Jiang CQ, Cheng KK, Lam TH, Lam KH, Miller MR, et al. Passive smoking exposure and risk of COPD among adults in China: the Guangzhou Biobank Cohort Study. Lancet. 2007;370(9589):751–7.

  76. 76.

    U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.

  77. 77.

    Jones LL, Hashim A, McKeever T, Cook DG, Britton J, Leonardi-Bee J. Parental and household smoking and the increased risk of bronchitis, bronchiolitis and other lower respiratory infections in infancy: systematic review and meta-analysis. Respir Res 2011; 12: 5.

  78. 78.

    Woodward A, Laugesen M. How many deaths are caused by secondhand cigarette smoke? Tob Control 2001;10:383–8.

  79. 79.

    Quan Gan, Kirk R Smith, S Katharine Hammond et al Disease burden of adult lung cancer and ischaemic heart disease from passive tobacco smoking in China, Tobacco Control 2007;16:417–422.

  80. 80.

    Wang JB, Jiang Y, Wei WQ, et al Estimation of cancer incidence and mortality attributable to smoking in China Cancer Cause Control (2010) 21:959–965.

  81. 81.

    Yang GH, Wang Yu, Christopher J L Murray, et al Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010, Lancet 2013; 381: 1987–2015.

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Yang, G. (2018). Tobacco Epidemic and Health Risk in the Chinese Population. In: Yang, G. (eds) Tobacco Control in China. Springer, Singapore. https://doi.org/10.1007/978-981-10-8315-0_2

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