EMERGING TOBACCO HAZARDS IN CHINA - I - RETROSPECTIVE PROPORTIONAL MORTALITY STUDY OF ONE MILLION DEATHS

Objective To assess the hazards at an early phase of the growing epide mic of deaths from tobacco in China Design Smoking habits before 1980 (obtained from family or other informants) of 0.7 million adults who h ad died of neoplastic, respiratory, or vascular causes were compared w ith those of a reference group of 0.2 million who had died of other ca uses. Setting 24 urban and '74 rural areas of China Subjects One milli on people who had died during 1986-8 and whose families could be inter viewed. Main outcome measures Tobacco attributable mortality in middle or old age from neoplastic, respiratory, or vascular disease. Results Among male smokers aged 35-69 there was a 51% (SE 2) excess of neopla stic deaths, a 31% (2) excess of respiratory deaths, and a 15% (2) exc ess of vascular deaths. All three excesses were significant (P < 0.000 1). Among male smokers aged greater than or equal to 70 there was a 39 % (3) excess of neoplastic deaths, a 54% (2) excess of respiratory dea ths, and a 6% (2) excess of vascular deaths. Fewer women smoked, but t hose who did had tobacco attributable risks of lung cancer and respira tory disease about the same as men. For both sexes, the lung cancer ra tes at ages 35-69 were about three times as great in smokers as in non -smokers, but because the rates among non-smokers in different parts o f China varied widely the absolute excesses of lung cancer in smokers also varied. Of all deaths attributed to tobacco, 45% were due to chro nic obstructive pulmonary disease and 15% to lung cancer; oesophageal cancer, stomach cancer; liver cancer, tuberculosis, stroke, and ischae mic heart disease each caused 5-8%. Tobacco caused about 0.6 million C hinese deaths in 1990 (0.5 million men). This will rise to 0.8 million in 2000 (0.4 million at ages 35-69) or to more if the tobacco attribu ted fractions increase. Conclusions At current age specific death rate s in smokers and non-smokers one in four smokers would be killed by to bacco, but as the epidemic grows this proportion will roughly double. If current smoking uptake rates persist in China (where about two thir ds of men but few women become smokers) tobacco will kill about 100 mi llion of the 0.3 billion males now aged 0-29, with half these deaths i n middle age and half in old age.