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Emerging tobacco hazards in China: 1. Retrospective proportional mortality study of one million deaths

BMJ 1998; 317 doi: (Published 21 November 1998) Cite this as: BMJ 1998;317:1411
  1. Bo-Qi Liu, professora,
  2. Richard Peto, professor (gale.mead{at},
  3. Zheng-Ming Chen, reader in epidemiologyb,
  4. Jillian Boreham, senior research fellowb,
  5. Ya-Ping Wu, research fellowa,
  6. Jun-Yao Li, epidemiologista,
  7. T Colin Campbell, professorc,
  8. Jun-Shi Chen, director.d
  1. aDepartment of Epidemiology, National Cancer Institute, Chinese Academy of Medical Sciences, Panjiayuan, Chaoyang District, Beijing 100021, People's Republic of China
  2. bClinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Clinical Medicine, Radcliffe Infirmary, Oxford OX2 6HE,
  3. cDivision of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
  4. dInstitute of Nutrition and Food Hygiene, Chinese Academy of Preventive Medicine, Beijing 100050, People's Republic of China
  1. Correspondence to: Professor Liu or Professor Peto


    Objective: To assess the hazards at an early phase of the growing epidemic of deaths from tobacco in China.

    Design: Smoking habits before 1980 (obtained from family or other informants) of 0.7 million adults who had died of neoplastic, respiratory, or vascular causes were compared with those of a reference group of 0.2 million who had died of other causes.

    Setting: 24 urban and 74 rural areas of China.

    Subjects: One million people who had died during 1986-8 and whose families could be interviewed.

    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 neoplastic deaths, a 31% (2) excess of respiratory deaths, and a 15% (2) excess of vascular deaths. All three excesses were significant (P<0.0001). Among male smokers aged align=baseline>70 there was a 39% (3) excess of neoplastic deaths, a 54% (2) excess of respiratory deaths, and a 6% (2) excess of vascular deaths. Fewer women smoked, but those who did had tobacco attributable risks of lung cancer and respiratory disease about the same as men. For both sexes, the lung cancer rates 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 of China varied widely the absolute excesses of lung cancer in smokers also varied. Of all deaths attributed to tobacco, 45% were due to chronic obstructive pulmonary disease and 15% to lung cancer; oesophageal cancer, stomach cancer, liver cancer, tuberculosis, stroke, and ischaemic heart disease each caused 5-8%. Tobacco caused about 0.6 million Chinese 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 attributed fractions increase.

    Conclusions: At current age specific death rates in smokers and non-smokers one in four smokers would be killed by tobacco, but as the epidemic grows this proportion will roughly double. If current smoking uptake rates persist in China (where about two thirds of men but few women become smokers) tobacco will kill about 100 million of the 0.3 billion males now aged 0-29, with half these deaths in middle age and half in old age.


    • Funding Medical Research Council and Imperial Cancer Research Fund in Britain; US National Institutes of Health grant No 5R01 CA 33638 to TCC, RP, JC and JL; and Chinese Academy of Medical Science and Ministry of Public Health in China.

    • Competing interest None.

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