WPost: Chinese Smoking Report (fwd)

[Robert Weissman <rob@essential.org>]

                  Smoking-Related Deaths in China Are Up
                  Sharply

                  By John Schwartz and John Pomfret
                  Washington Post Staff Writers
                  Friday, November 20, 1998; Page A01 

                  Smoking causes about 750,000 premature deaths in China
each year and
                  will kill 3 million a year by the middle of the next
century if present trends
                  continue, according to the largest-ever studies of
tobacco's risks, which
                  were released yesterday.

                  The research, the first nationwide examination of smoking
trends in the
                  developing world, provides the most compelling evidence
yet of how
                  global smoking patterns are shifting -- with rates falling
in Western
                  countries but rising in developing nations -- and
threatening to become the
                  world's leading public health problem, experts said.

                  Thus, the studies provide an unprecedented opportunity for
researchers
                  and public health officials to watch -- and, they hope,
fight -- a
                  tobacco-disease epidemic as it unfolds.

                  The studies, which were published today in the British
Medical Journal and
                  announced at news conferences in London and Beijing,
involved two
                  separate research projects: One examined a million deaths
in 24 major
                  cities and 74 rural counties to determine the medical
causes, while a
                  second is tracking the health of a quarter-million men age
40 and older.

                  China now has the distinction of losing more of its
citizens to
                  tobacco-related illnesses than any other nation, having
recently passed the
                  United States. The country smokes 30 percent of the
world's cigarettes,
                  and two-thirds of male Chinese become smokers by the age
of 25.

                  Chinese consumption has jumped -- from 100 billion
cigarettes a year in
                  the early 1950s to 500 billion in 1980 and 1.8 trillion
today. Average daily
                  consumption rose from one per Chinese man in 1952 to four
in 1972 and
                  10 in 1992.

                  By comparison, Americans smoked one cigarette per adult
daily in 1910,
                  four in 1930 and 10 in 1950.

                  A lead researcher on one of the studies, Niu Shiru of the
Chinese
                  Academy of Preventive Medicine, said that these statistics
mean that more
                  than 100 million male Chinese of the 300 million now age
29 and younger
                  will be killed by tobacco-related illnesses.

                  Worldwide, 10 million people a year will die from
tobacco-related illnesses
                  by 2030, with 70 percent of them coming from developing
nations, Alan
                  Lopez, chief of the World Health Organization's division
of epidemiology
                  and burden of disease, wrote in an editorial accompanying
the studies.
                  "The hazards are already substantial, and they cannot be
limited to China,"
                  Lopez noted.

                  On one level, the immense, 10-year effort merely proves
the obvious: that
                  smoking is hazardous to health.

                  But while Chinese increases in smoking and death rates
uncannily echo the
                  path tobacco cut through American health about 40 years
before, the
                  patterns of illness differ in ways that could shed light
on how tobacco kills,
                  said Richard Peto of Oxford University, lead author of one
of the studies.

                  Because the upward curves of smoking habits in both
countries are so
                  similar, the upward curves of disease appear to be
tracking as well. In
                  1950, 12 percent of all American deaths were attributable
to smoking, and
                  today 33 percent are. Today, 12 percent of deaths in China
can be
                  attributed to smoking, according to the researchers; by
the middle of the
                  next century, if the growth in diseases continues to
mirror the American
                  experience, that figure could rise to 33 percent.

                  Smoking in the United States leads to a sharp rise in the
risk of lung cancer
                  and heart disease, but in China increases in the rates of
emphysema and
                  tuberculosis are more common, Peto said. The differences
can be
                  attributed to the fact that tobacco use amplifies the
effects of diseases that
                  are already common, Peto said.

                  The researchers suggested that the high-fat American diet
contributes to
                  heart disease rates in the United States, while China's
intense urban air
                  pollution boosts its rates of lung disease.

                  Tobacco has a prominent position in Chinese culture; Mao
Tse-tung had
                  pledged that the Communist state would provide enough
food, shelter and
                  cigarettes for everyone. "They just saw cigarettes as a
bit of luxury for
                  people with tough lives," Peto said.

                  Most of the cigarettes in the country are manufactured in
state-owned
                  operations, although several foreign cigarette companies have
                  joint-manufacturing agreements with the Chinese
government. The
                  government has launched programs to reduce tobacco use,
but those
                  efforts have so far been ineffective.

                  Niu said he is concerned because despite some attempts to
educate the
                  Chinese about the dangers of smoking, people seem to think
that smoking
                  doesn't really affect their health.

                  "Two-thirds of the people out there in China think tobacco
won't harm
                  you," he said. "That is shocking."

                  Indeed, Zhang Jianguo, a 58-year-old guard at Niu's
institute, said he is a
                  confirmed smoker. "Heh, there are so many other things
that will kill me,"
                  he said. "What's wrong with a little tobacco?"

                  If adults can be convinced to give up the habit, "you
could halve the
                  number of tobacco deaths by the beginning of the next
century," Peto said.

                  Women in China are far less likely to smoke than men, and
smoking rates
                  among women are dropping. Tobacco currently accounts for
only 3
                  percent of their deaths, the researchers said.

                  The unprecedented size of the research project presented
daunting
                  logistical challenges for the scientists. But such
research is easier to
                  conduct in China than in other nations, Peto said, because
of the nation's
                  legacy of authoritarian rule. "There was a tradition left
over from the
                  1970s, when you could say 'do it' and they did it."

                  An American lawmaker who has pushed for the federal
government to
                  become more involved in international tobacco control
efforts said
                  yesterday that the data in the two reports were "truly
appalling." Rep.
                  Lloyd Doggett (D-Tex.), who has sponsored legislation that
would ban
                  U.S. government promotion of American tobacco sales
abroad, compared
                  the prospect of multinational tobacco companies promoting
the nicotine
                  market to the opium wars.

                  Pomfret reported from Beijing; Schwartz reported from
Washington.


                           © Copyright 1998 The Washington Post Company



THREE MILLION TOBACCO DEATHS A YEAR IN
CHINA BY MIDDLE OF NEXT CENTURY

MANY DEVELOPING COUNTRIES FACE SIMILAR EPIDEMIC SAY
RESEARCHERS

China is undergoing a catastrophic epidemic of smoking deaths. A third of
all its young men will eventually be killed by tobacco
if current smoking patterns persist, according to research published Friday
20 November (1998) in the British Medical Journal.

Smoking already kills over 2,000 people every day in China (mostly men). By
2050 this will be well over 8,000. China now
has the biggest number of deaths from smoking of any country, having
recently overtaken the USA. 

Annual smoking deaths in China will be: 

     1 million by around the year 2000 
     2 million around 2025 
     3 million around 2050 

Of those killed by tobacco in China: 

     45% die from chronic lung disease 
     15% from lung cancer 
     5-8% from each of oesophagus cancer, stomach cancer, liver cancer,
stroke, heart disease and, surprisingly,
     tuberculosis. 
     Of over 300 million males now aged 0-29, at least 100 million will
eventually be killed by tobacco. Half the deaths will
     be at ages 35 to 69. 

The findings are from the world's largest-ever investigation into tobacco
deaths. Researchers from the Chinese Academies of
Preventive Medicine and Medical Sciences collaborated with Oxford University
(England) and Cornell University (USA),
interviewing a million families of people who had died and a quarter of a
million other people. These novel research methods
are now being used to monitor smoking hazards in Russia, Poland, Cuba,
Mexico, Egypt, India and South Africa. 

Results were presented today (19 November) in Beijing and at a British
Medical Journal news conference in London. 

Professor Richard Peto of Oxford University told the London conference:
"Chinese adults severely underestimate smoking
risks. A 1996 nationwide survey showed that two-thirds believe smoking does
little or no harm, 60% of Chinese adults
don't know that smoking can cause lung cancer and 96% don't know it can
cause heart disease. The truth is that half
of all persistent smokers get killed by tobacco. As two out of every three
young men in China smoke, tobacco will
eventually kill about a third of all the young men in China." 

Chinese men smoke far more cigarettes than they used to, but, surprisingly,
the smoking changes are opposite for women.
Before 1950, 10% of young Chinese women became smokers, but for unknown
reasons only 1% do now. However, there is
still a danger of a large increase. 

Many developing countries will be hit by big epidemics of death from
smoking. Worldwide tobacco deaths on current smoking
patterns will be: 

     4 million in 2000 - half in rich, half in poor countries 
     10 million by about 2030 - 70% in developing countries 

But, big decreases are also possible. Thirty years ago, Britain had the
worst smoking death rates in the world. Then people
accepted smoking was hazardous and annual cigarette sales in Britain slumped
from 150 billion to 80 billion over a thirty year
period. Consequently, annual UK tobacco deaths in middle age halved from
80,000 in 1965 to 40,000 in 1995. Britain now
has the world's largest decrease in premature deaths from smoking. 

Said Prof Peto: "If worldwide cigarette consumption per adult could be
halved by 2020, we'd avoid 25 million deaths
from tobacco in the first quarter of the century and 150 million in the
second quarter. If smokers quit before they have
cancer, or some other serious disease, they avoid most of the risk of death
from tobacco. If they don't, there is a 50/50
chance they will die from their habit." 

Notes: 

   1.Cigarette consumption in China: annual consumption rose from 100
billion in the early 1950s to 500 billion in 1980 and
     currently stands at 1,800 billion. Average daily cigarette consumption
by males was 1 in 1952, 4 in 1972, 10 in 1992. 
   2.The research was supported by the UK Medical Research Council, a major
UK cancer charity(ICRF), the US National
     Institutes of Health, the Canadian Government and World Bank. 
   3.A video news release filmed chiefly in China will be available in a
version suitable for English-language media, and in an
     alternative version for Chinese language media. 
   4.From 19 November, full details will also be available on the CTSU &
Globalink websites. 
          CTSU: http://www.ctsu.ox.ac.uk/tobacco/ 
          Globalink: http://www.uicc.org/tcpr/ 

Further information Margaret Willson, m.willson@dial.pipex.com 



EMERGING TOBACCO HAZARDS IN CHINA - WORLD FIRST
STUDY FOR CHINESE SCIENTISTS

RESEARCHERS PREDICT 3 MILLION SMOKING DEATHS A YEAR IN CHINA BY MIDDLE
OF NEXT CENTURY AND BIG INCREASES IN MANY OTHER COUNTRIES

Results from the world's largest investigation into tobacco deaths,
'Emerging tobacco hazards in China', are published (Friday
20 November), in the British Medical Journal. 

This unique project is a world-first for China, being the first nationwide
study of tobacco's effects in a developing country and
introducing novel research methods that are rapidly being adopted in many
other countries to study tobacco deaths. It has been
carried out by researchers from two leading Chinese scientific institutions
(Chinese Academy of Preventive Medicine and
Chinese Academy of Medical Sciences) in collaboration with researchers from
Oxford University, England and Cornell
University, USA. 

Background

There are two studies - a "retrospective" study of novel design that
interviewed the families of one million dead people to find
out whether the dead person had smoked, and one ongoing nationally
representative prospective study in which a quarter of a
million adults were interviewed about their own smoking habits and have been
followed for several years to see what they die
from. The objective was to assess the hazards at an early phase of the
growing epidemic of deaths from tobacco in China and,
by continuing the prospective study for another few decades, to monitor the
future growth of the epidemic. 

The retrospective study compared the smoking habits of 0.7 million adults
who had died of cancer, respiratory or vascular
causes with those of a "reference group" of 0.2 million adults who had died
of other causes (calculating, for example, the excess
risk of lung cancer among smokers from the excess of smokers among those who
had died from lung cancer). The fieldwork
involved over 500 interviewers in 24 major cities and 74 rural counties that
are reasonably nationally representative of China. 

The prospective study sought out a quarter of a million men aged over 40
from nationally representative disease surveillance
points and weighed, measured, interviewed and carried out medical tests on
225,000 (over 85 per cent of the total). Mortality
and causes of death have been monitored by annual visits. This prospective
study will continue for decades, tracing the growth
of the epidemic. Its preliminary results confirm the more detailed findings
of the retrospective study. 

Countries in Asia, Africa, Eastern Europe and Latin America that are now
beginning to use these methods include Russia,
Poland, Cuba, Mexico, Egypt, India and South Africa. 

The research is a collaboration between the Chinese Academy of Preventive
Medicine, Beijing (CAPM), the Chinese
Academy of Medical Sciences, Beijing (CAMS), the Clinical Trial Service Unit
and Epidemiological Studies Unit (CTSU) at
Oxford University, England and Cornell University, Ithaca, New York, USA. It
was funded in China by the CAMS, the
Ministry of Public Health, the World Bank and the Canadian government, in
England by a leading cancer charity (ICRF) and
the UK Medical Research Council and in the USA by the National Institutes of
Health. 

Cigarette consumption in China

Annual Chinese cigarette consumption grew from 100 billion in the early
1950s to 500 billion in 1980 and is now 1,800 billion.
One in three of all the cigarettes smoked in the world today are smoked in
China. 

Average daily consumption per man was one cigarette in 1952, 4 in 1972 and
10 in 1992, but it now appears to have
stabilised. The pattern of consumption of Chinese men has been like that in
US adults (where average daily consumption per
adult was 1 cigarette in 1910, 4 in 1930 and 10 in 1950) except that the
main increase has taken place 40 years later. At
present, two-thirds of Chinese men (but only 1% of the women) become smokers
before the age of 25. 

But, although male smoking has increased, female smoking has decreased, for
unknown reasons. Before 1950, 10% of young
women became tobacco smokers in the cities of China (and many of those who
did are now dying from its effects) but
nowadays only 1% of young women become smokers. 

Findings - the retrospective study

Among male smokers aged 35-69 there was: 

     a 51% excess of cancer deaths 
     a 31% excess of respiratory deaths 
     a 15% excess of vascular deaths 

Among male smokers aged 70+ there was: 

     a 39% excess of cancer deaths 
     a 54% excess of respiratory deaths 
     a 6% excess of vascular deaths 

Fewer females smoked, but those who did had smoking-attributed risks of lung
cancer and respiratory disease about as great
as for males. 

In some Chinese cities even the non-smokers are at fairly high risk of lung
cancer, perhaps because of coal smoke and cooking
fumes in the houses, but in other cities lung cancer is rare in non-smokers.
For both sexes in all cities, however, the lung cancer
rates at ages 35-69 were consistently about three times as great in smokers
as in non-smokers and the overall cancer risks
among smokers were about 50% greater than for non-smokers. 

Likewise, in many areas even the non-smokers are at substantial risk of
chronic lung disease, but everywhere the risk is bigger
for smokers - indeed, respiratory disease is the most important health
hazard from tobacco in China. For stroke and ischaemic
heart disease the risk ratios comparing smokers versus non-smokers were not
extreme, but it is still likely that the moderate
excess of these diseases among smokers is partly or wholly causal as studies
in other countries have found a strong relationship
between prolonged cigarette use and vascular disease in middle age. 

When all diseases were taken into account, the excess risk of death among
smokers was greatest for those who started in early
adult life. 

Of all deaths attributed to tobacco: 

     45% involved chronic obstructive pulmonary disease 
     15% involved lung cancer. 
     5-8% involved each of oesophagus cancer, stomach cancer, liver cancer,
stroke, heart disease and, surprisingly,
     tuberculosis (TB) 

The main way that smoking kills people in China is by making diseases that
are already common, even more common. For
example, among men in urban China those smoking more than 20 cigarettes a
day had double the non-smoker TB death rates. 
So, in 1990, tobacco caused: 

     0.6 million Chinese deaths (0.8 million in the year 2000) 
     0.3 million deaths at ages 35-69 (0.4 million in the year 2000) 
     12% of male deaths (but increasing) 
     3% of female deaths (probably decreasing) 

When the young smokers of today reach old age, tobacco will be causing about: 

     3 million deaths a year 
     33% of male deaths 
     1% of female deaths 

As the epidemic evolves, tobacco will kill: 

     1 smoker in 2 

Conclusion: Half of those now becoming persistent smokers will eventually be
killed by tobacco in middle or old age.
Tobacco will kill at least 100 million of the over 300 million males now
aged 0-29. Half these deaths will be in middle age and
half in old-age. 

Findings - the prospective study

In 1990: 

     73% of men smoked (68% urban, 75% rural) 
     The overall mortality was greatest among those who started smoking in
early adult life 
     The excess mortality among smokers chiefly involved cancer, respiratory
and vascular disease 
     These associations are largely causal, so tobacco currently causes 12%
of all male deaths in China 
     The overall risk ratio for smokers starting before the age of 20 is
already 1.34, implying that even at current death rates
     about 1 in 4 smokers will be killed by tobacco. But, this risk ratio
has already grown much bigger in the cities and will do
     likewise in rural areas, as the generations that did not smoke
cigarettes regularly are succeeded by the generations that
     have done so. 
     In urban areas, where a greater proportion of tobacco use involves
cigarettes, the risk ratio for those who began before
     age 20 is already approaching 2, suggesting that half of all smokers
will be killed by tobacco. 

Conclusion: The prospective study and the retrospective study both indicate
that in the early 1990s smoking was already
responsible for about 12% of all adult male deaths, which currently
corresponds to 0.7 million male deaths, plus about 3% (0.1
million) of all adult female deaths. The current health effects, however,
chiefly reflect past smoking patterns. On present
smoking patterns, the death rates of smokers will become double those of
nonsmokers of the same age, suggesting that about
half of today's young smokers will eventually be killed by tobacco. 

Medical Implications

     Of the Chinese deaths now being caused by tobacco, 45% are from chronic
lung disease, 15% from lung cancer and
     5-8% from each of oesophagus cancer, stomach cancer, liver cancer,
stroke, ischaemic heart disease and tuberculosis. 
     Tobacco now causes 12% (and will probably eventually cause about 33%)
of adult male deaths, but only 3% (and
     perhaps eventually only about 1%) of adult female deaths in China: the
hazards of tobacco are similar for both sexes, but
     the proportion of young women who smoke has become very small. 
     2 in 3 males now become smokers before age 25. Few give up, and about
half of those who persist will be killed by
     tobacco in middle or old age. So, on present smoking patterns at least
100 million of the over 300 million Chinese males
     now aged 0-29 will eventually be killed by tobacco. 
     In China, tobacco caused 0.6 million deaths in 1990 and will cause 0.8
million in 2,000 (0.7 million male).On present
     smoking patterns, annual tobacco deaths will reach 1 million before
2010, 2 million by about 2025 and 3 million (almost
     all male) when, in the middle of the century, today's young adults
reach old age. 


Published: Emerging tobacco hazards in China: Part 1, Proportional mortality
study of one million deaths. Part 2, Early results
from a Chinese national prospective study. British Medical Journal. 21
November 1998. 

>From 19 November 1998, full details will also be available on the CTSU &
Globalink websites. 

     CTSU: http://www.ctsu.ox.ac.uk/tobacco/ 
     Globalink: http://www.uicc.org/tcpr 

Further information: Margaret Willson m.willson@dial.pipex.com