Mortality attributable to smoking in China.
BACKGROUND
Smoking is a risk factor for many diseases and has been increasingly prevalent in economically developing regions of the world. We aimed to estimate the number of deaths attributable to smoking in China.


METHODS
We conducted a large, prospective cohort study in a nationally representative sample of 169,871 Chinese adults who were 40 years of age or older. Investigators for the China National Hypertension Survey collected data on smoking and other risk factors at a baseline examination in 1991 using a standard protocol. Follow-up evaluation was conducted in 1999 and 2000, with a response rate of 93.4%. We used multivariable-adjusted relative risk, prevalence of smoking, mortality, and population size in each age group, stratified according to sex, to calculate the number of deaths attributable to smoking in 2005.


RESULTS
There was a significant, dose-response association between pack-years smoked and death from any cause in both men and women after adjustment for multiple risk factors (P<0.001 for trend). We estimated that in 2005, a total of 673,000 deaths (95% confidence interval [CI], 564,700 to 781,400) were attributable to smoking in China: 538,200 (95% CI, 455,800 to 620,600) among men and 134,800 (95% CI, 108,900 to 160,800) among women. The leading causes of smoking-related deaths were as follows: cancer, 268,200 (95% CI, 214,500 to 321,900); cardiovascular disease, 146,200 (95% CI, 79,200 to 213,100); and respiratory disease, 66,800 (95% CI, 20,300 to 113,300).


CONCLUSIONS
Our study documents that smoking is a major risk factor for mortality in China. Continued strengthening of national programs and initiatives for smoking prevention and cessation is needed to reduce smoking-related deaths in China.
Gu
Dongfeng
D
Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. gudf@yahoo.com
Kelly
Tanika N
TN
Wu
Xigui
X
Chen
Jing
J
Samet
Jonathan M
JM
Huang
Jian-feng
JF
Zhu
Manlu
M
Chen
Ji-chun
JC
Chen
Chung-Shiuan
CS
Duan
Xiufang
X
Klag
Michael J
MJ
He
Jiang
J
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality; D015995:Prevalence; D012306:Risk; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology / Q000401:mortality*