MORTALITY ATTRIBUTABLE TO CIGARETTE-SMOKING IN CHINA

Context.-The few published prospective studies of smoking and mortalit y in China have reported low relative risks, but the durations of foll ow-up were short. Objective.-To assess the mortality of ever-and never -smokers in a cohort after 20 years of follow-up. Design, Setting, and Subjects.-A cohort analytic study in a machinery factory in Xi'an, Ch ina, involving 1696 people aged 35 years or older (1124 men and 572 ME THODS women) examined in May 1976. Main Outcome Measures.-All-cause an d tobacco-associated mortality. Results.-A total of 56% of the men and 12% of the women were ever-smokers at baseline. Through August 31, 19 96, 218 persons (173 men and 45 women) had died. The relative risks (9 5% confidence intervals [CIs]) for ever smoking (after adjusting for a ge, marital status, occupation, education, diastolic blood pressure, a nd triglyceride and cholesterol levels) for deaths resulting from all causes, all cancer, and coronary heart disease were, respectively, 2.4 2 (95% CI, 1.72-3.42), 2.50 (95% CI, 1.41-4.43), and 3.61 (95% CI, 1.3 5-9.67) in men and 2.32 (95% CI, 1.18-4.56), 1.98 (95% CI, 0.50-7.92), and 4.67 (95% CI, 0.78-27.8) in women. Conclusions.-Previous prospect ive studies of smoking-related mortality in China tended to underestim ate the risks, probably because of short durations of follow-up. We ha ve demonstrated that smoking is a major cause of death in China, and t he risks are similar to those seen in the United States and the United Kingdom. Thus, about half of the 300 million smokers in China will ev entually die of smoking-related diseases if urgent tobacco-control mea sures are not instituted to prevent this growing epidemic.