The number of deaths from smoking-related cancers in China is expected to rise by nearly 50% over the next two decades, according to research published online in the journal Tobacco Control.
Experience from other countries where peaks in smoking prevalence occurred in the mid-twentieth century have shown that peaks in smoking-related deaths typically do not occur until decades later.
For example, in the United States, smoking prevalence peaked in 1955 among men and 1965 among women, but the peak in lung cancer deaths came about four decades later—in the 1990s for men and the 2000s for women.
The smoking epidemic in China started three to four decades later than in the United States, so the spike in lung cancer deaths is yet to come, the researchers warn.
They used data from a variety of sources, including the China Death Surveillance Database and studies of smoking patterns in China, to model the likely course of smoking-related deaths over the next 20 years.
Between 2002 and 2018, smoking prevalence in China decreased from 57.4% to 50.5% in men and from 2.6% to 2.1% in women. If smoking prevalence continues to decline at the same rate, smoking prevalence will be 41.3% among men and 2.16% among women by 2040.
But when the aging population is taken into account, the researchers estimate that the number of deaths from smoking-related cancers will increase by 44% among men between 2020 and 2040 (from 337.2/100 000 to 485.6/ 100,000) and by almost 53% among women (from 157.3/100,000 to 240.4/100,000).
In 20 years, there would be 8.6 million additional deaths from smoking-related cancers in China, equivalent to 117.3 million life years lost. Nearly half (46%) of life years lost are said to come from working-age adults (54.1 million); 94% of this (110.3 million) would be lost in men.
The Healthy China initiative aims to improve the health of the Chinese population, the largest in the world. The goal is to reduce the total smoking rate to 20% by 2030.
If this goal is met, the smoking rate among men would fall to just over 26% by 2040, with about 1.4 million additional deaths avoided, the researchers calculate.
“The observed rate of decline in smoking prevalence is far from what is needed to meet the Healthy China 2030 target,” they write. “Even if this goal were achieved, the rising trend in deaths would be reversed only slightly.”
The researchers highlight several potential limitations of their study, which likely mean that future smoking-related deaths are an underestimate.
And the lack of age-specific past smoking rates prevented the analysis from fully taking into account the impact of smoking in people who had quit, nor did it take into account smoking-related deaths from causes other than cancer or those related to second-hand smoking. .
The assumptions of smoking trends across age groups and cancer death rates were also based on limited data, not including increases in life expectancy over time.
But they warn: “Unless families, communities and society as a whole make widespread efforts to support smoking cessation, the massive loss of life among the workforce over the next 20 years will certainly contribute to the increasing difficulty in supporting China’s aging society and will exceed the magnitude that a single existing intervention can prevent.”
Since about 22% of daily smokers started as children or adolescents, “complete prevention of smoking use among adolescents is imperative for future generations to avoid the ill effects of smoking-related diseases,” they add.
Li, N., et al. (2021) Smoking-related cancer mortality in men and women in an aging society (China 2020-2040): a population-based modeling study. tobacco control. doi.org/10.1136/tabaccocontrol-2020-056444.