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Trends in the tobacco-attributable DALY rates per 100,000 people in Chinese females (A) and males (B) from 1990 to 2017. DALY, disability-adjusted life year; YLL, years of life lost due to premature death; YLD, years lived with disability. Income-divided countries from the World Bank.
Source publication
In 2018, there were more than 371 million cigarette smokers and 12. 6 million electronic cigarette users, with 340.2 million non-smokers exposed to secondhand smoke (SHS) in China, which resulted in heavy tobacco-attributable disease burden. According to the definition by the Global Burden of Disease Study 2017 (GBD 2017), tobacco is a level 2 risk...
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Citations
... Past studies in China have focused on the burden of specific conditions such as cancer and cardiovascular disease [14][15][16][17], or specific risk factors such as tobacco [18,19]. Yet, there is little evidence of the relative effects attributable to multiple modifiable risk factors. ...
Background
Estimating the economic burden of modifiable risk factors is crucial for allocating scarce healthcare resources to improve population health. We quantified the economic burden attributable to modifiable risk factors in an urban area of China.
Methods
Our Shanghai Municipal Health Commission dataset covered 2.2 million inpatient admissions for adults (age ≥ 20) in public and private hospitals in 2015 (1,327,187 admissions) and 2020 (837,482 admissions). We used a prevalence-based cost-of-illness approach by applying population attributable fraction (PAF) estimates for each modifiable risk factor from the Global Burden of Diseases Study (GBD) to estimate attributable costs. We adopted a societal perspective for cost estimates, comprising direct healthcare costs and productivity losses from absenteeism and premature mortality. Future costs were discounted at 3% and adjusted to 2020 prices.
Results
In 2020, the total societal cost attributable to modifiable risk factors in Shanghai was US$7.9 billion (95% uncertainty interval [UI]: 4.6–12.4b), mostly from productivity losses (67.9%). Two health conditions constituted most of the attributable societal cost: cancer (51.6% [30.2–60.2]) and cardiovascular disease (31.2% [24.6–50.7]). Three modifiable risk factors accounted for half of the total attributable societal cost: tobacco (23.7% [16.4–30.5]), alcohol (13.3% [8.2–19.7]), and dietary risks (12.2% [7.5–17.7]). The economic burden varied by age and sex; most of the societal costs were from males (77.7%), primarily driven by their tobacco and alcohol use. The largest contributor to societal costs was alcohol for age 20–44, and tobacco for age 45 + . Despite the COVID-19 pandemic, the pattern of major modifiable risk factors remained stable from 2015 to 2020 albeit with notable increases in attributable healthcare costs from cancers and productivity losses from cardiovascular diseases.
Conclusions
The substantial economic burden of diseases attributable to modifiable risk factors necessitates targeted policy interventions. Priority areas are reducing tobacco and alcohol consumption and improving dietary habits that together constitute half of the total attributable costs. Tailored interventions targeting specific age and sex groups are crucial; namely tobacco in middle-aged/older males and alcohol in younger males.
... Active smoking, widely accepted as a behavior, particularly prevalent among males, is believed to stimulate social interaction and alleviate stress (33). Furthermore, in contrast to smoking, chewing tobacco is associated with comparatively fewer deaths and DALYs (34). Nevertheless, caution should still be exercised regarding the future burden of diseases caused by chewing tobacco. ...
Aims
This study addresses the essential need for updated information on the burden of lip and oral cavity cancer (LOC) in China for informed healthcare planning. We aim to estimate the temporal trends and the attributable burdens of selected risk factors of LOC in China (1990–2021), and to predict the possible trends (2022–2031).
Subject and methods
Analysis was conducted using data from the Global Burden of Disease study (GBD) 2021, encompassing six key metrics: incidence, mortality, prevalence, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Absolute number and age-standardized rates, alongside 95% uncertainty intervals, were computed. Forecasting of disease burden from 2022 to 2031 was performed using an autoregressive integrated moving average (ARIMA) model.
Results
Over the observed period (1990–2021), there were notable increases in the number of deaths (142.2%), incidence (283.7%), prevalence (438.0%), DALYs (109.2%), YLDs (341.2%), and YLLs (105.1%). Age-standardized rates demonstrated notable changes, showing decreases and increases of −5.8, 57.3, 143.7, −8.9%, 85.8%, and − 10.7% in the respective metrics. The substantial majority of LOC burden was observed among individuals aged 40–79 years, and LOC may exhibit a higher burden among males in China. From 2022 to 2031, the age-standardized rate of incidence, prevalence, and YLDs of LOC showed upward trends; while mortality, DALYs, and YLLs showed downward trends, and their estimated values were predicted to change to 2.72, 10.47, 1.11, 1.10, 28.52, and 27.43 per 100,000 in 2031, respectively. Notably, tobacco and high alcohol use emerged as predominant risk factors contributing to the burden of LOC.
Conclusion
Between 1990 and 2021, the disability burden from LOC in China increased, while the death burden decreased, and projections suggest these trends will persist over the next decade. A significant portion of this disease burden to modifiable risk factors, specifically tobacco use and excessive alcohol consumption, predominantly affecting males and individuals aged 40–79 years. Attention to these areas is essential for implementing targeted interventions and reducing the impact of LOC in China.
... This misconception is furthered by marketing and advertising. Second, smoking has become a custom in Chinese social relations, where it is customary to gift cigarettes as a 14 token of friendship, which promotes smoking initiation. Thirdly, smoking start is influenced by social shifts and stressors related to urban migration, especially for 15 migratory workers from rural to urban areas. ...
China accounts for almost one-third of worldwide tobacco production and consumption, and despite current tobacco control efforts, the smoking rate remains frighteningly high, with 350 million smokers and 740 million passive smokers. Alarmingly, more young people and women are becoming smokers. With 1.2 million fatalities linked to tobacco use each year, the related mortality rate is startling, and estimates indicate that number will rise to 2 million by 2025. The tobacco industry's strong opposition, sociocultural factors that encourage smoking start, a lack of public knowledge about the dangers of smoking, and insufficient government backing are all blamed for the ineffectiveness of the present tobacco control policies. Government commitments are required in order to carry out effective and urgent intervention activities. It is imperative to take comprehensive action at several levels, such as lowering the availability of tobacco products, raising taxes on tobacco products, improving public health education, restricting tobacco advertising, lowering secondhand smoke exposure, and offering strong support for quitting smoking. To address this important public health issue, the healthcare community should take the lead in anti-tobacco initiatives and actively participate in smoking cessation programs.
... As the world's largest tobacco consumer, China has suffered a heavy tobacco-attributable disease burden. More than one quarter of the Chinese population are current smokers [22,23], and evidence shows that tobacco-attributable death rates and tobacco-attributable disabilityadjusted life year rates have both increased significantly among Chinese men from 1990 to 2017 [22][23][24]. The adverse effect of smoking on health and wellbeing might vary by age, sex and educational level [25]. ...
... The adverse effect of smoking on health and wellbeing might vary by age, sex and educational level [25]. Specifically, the disease burden caused by smoking tends to be more severe for middle-aged and older adults due to the cumulative harmful effect caused by a long smoking experience period [19,26,27], and is generally more prominent among men given male higher rates in using of all tobacco products [20,24]. Additionally, the adverse effect of smoking on health might be less significant among well-educated people given that the more socioeconomically advantaged individuals tend to smoke less and have relatively easier access to health and medical resources compared with socioeconomically disadvantaged individuals [28,29]. ...
Objectives
Middle-aged and older adults smoking for years are afflicted by smoking-related diseases and functional limitations; however, little is known about the effect of smoking on nonfatal conditions in middle and later life. This study aims to investigate the impact of smoking on both total life expectancy (TLE) and disability-free life expectancy (DFLE) and the variations in such effects by educational level in China.
Methods
Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS), 2011–2018, with a total sample of 16,859 individuals aged 45 years or older involved in the final analysis. The Activities of Daily Living (ADL) scale was used to measure disability, and the population-based multistate life table method was used to estimate the differences in TLE and DFLE by smoking status and educational attainment.
Results
At baseline, 28.9% of participants were current smokers, 8.5% were former smokers, and 62.6% never smoked. Approximately 5.6% were identified with ADL disability. Both current smokers and former smokers experienced lower TLE and DFLE than never smokers, and such differences were particularly prominent among men. Intriguingly, former smokers manifested a lower DFLE for both sexes and a lower TLE among women, though a longer TLE among men, compared with current smokers. Similar differences in TLE and DFLE by smoking status were observed for groups with different levels of education.
Conclusion
Never smokers live longer and healthier than current smokers and persons who quit smoking. Smoking was associated with greater reductions in TLE and DFLE among men. However, educational attainment might not moderate the adverse effect of smoking on both fatal and nonfatal conditions in the context of China. These findings have implications for disability prevention, aged care provision and informing policies of healthy aging for China and elsewhere.
... Smoking is also a major contributor to the global disease burden 3 . Most deaths from smoking are attributable to chronic obstructive pulmonary disease, ischemic heart disease, lung cancer, and stroke 4 . Studies have found that smoking cessation before the age of 40 years can reduce the odds for smoking-related death by about 90% 5 . ...
INTRODUCTION
Tobacco smoking is a major risk factor for various diseases worldwide, including pancreatic exocrine diseases such as pancreatitis and pancreatic cancer (PC). Currently, few studies have examined the impact of smoking cessation on the likelihood of common pancreatic exocrine diseases. This study sought to determine whether smoking cessation would reduce pancreatitis and PC morbidity.
METHODS
This cohort study used data from the UK Biobank (UKB) to examine the association between smoking status and the likelihood of pancreatitis and PC among 492855 participants. The subjects were divided into never smokers, ex-smokers, and current smokers. Using a multivariate-adjusted binary logistic regression model, we analyzed the relationship between different smoking conditions and the likelihood of pancreatitis and PC. Further, we studied the impact of smoking cessation on pancreatitis and PC compared with current smoking.
RESULTS
After adjusting for potential confounders, current smokers had higher odds for acute pancreatitis (AP) (AOR=1.38; 95% CI: 1.18–1.61), chronic pancreatitis (CP) (AOR=3.29; 95% CI: 2.35–4.62) and PC (AOR=1.72; 95% CI: 1.42–2.09). People who quit smoking had comparable odds for the diseases as those who never smoked. Compared with current smokers, ex-smokers had reduced odds for AP (AOR=0.76; 95% CI: 0.64–0.89), CP (AOR=0.31; 95% CI: 0.21–0.46), and PC (AOR=0.62; 95% CI: 0.50–0.76). Subgroup analysis revealed reduced odds for these pancreatic diseases in males and females.
CONCLUSIONS
Smokers have an increased odds for pancreatitis and pancreatic cancer. Moreover, smoking cessation can significantly reduce the odds for acute pancreatitis, chronic pancreatitis and pancreatic cancer.
... Also being in a social environment that is more susceptible to anxiety and depression is a barrier to quitting [37]. A study in China found that in 1990, the focus of female tobacco control was passive smoking, but in 2017, smoking and passive smoking became equally crucial for female tobacco control [38]. There is less research on risk factors for female-specific IHD, and related studies have found that passive smokers are more likely to develop IHD, so public health interventions and policy development targeting the female population are necessary [39,40]. ...
Introduction
Smoking increases the risk of various cardiovascular diseases, including ischemic heart disease (IHD). This study aimed to assess the impact of age, period, and cohort on long-term trends in IHD mortality in China, India, Indonesia, the United States, and Russia, the five countries with the highest number of smokers, from 1990 to 2019.
Material and methods
The data were obtained from the Global Burden of Disease (GBD) Study 2019, and the age-standardized mortality rate (ASMR) was calculated. Joinpoint regression analysis was used to assess the magnitude and direction of trends in smoking-attributable mortality from IHD. Age-period-cohort (APC) studies were used to estimate net drift (estimated annual percentage change (EAPC)s), local drift (age-specific EAPCs), and independent trends in age, period, and cohort effects.
Results
The analysis revealed a significant downward trend in ASMRs attributable to IHD as a result of smoking in the United States, India, and Russia. Indonesia and China showed an upward trend. Age effects were increasing for both country and sex, with China showing the most significant increase in the older age group; period effects were decreasing in all countries except Indonesia, and cohort effects were increasing only in Indonesia and China.
Conclusions
From 1990 to 2019, mortality from IHD caused by smoking showed a downward trend in these five countries. However, the pattern of increased mortality from IHD in women caused by smoking warrants further study.
... During the study period of 2011 to 2017, the rates of YLLs, YLDs, and DALYs due to communicable, maternal, neonatal, and nutritional conditions largely decreased, while those caused by noncommunicable diseases generally increased. The national disease burden has, therefore, shifted considerably Zhang et al. 2018;Wen et al. 2020;Wang et al. 2021a, b). ...
Ischemic heart disease (IHD) is a major barrier to sustainable human development and is associated with various modifiable risk factors. The aim of this study was to estimate the IHD burden attributable to 18 risk factors in Nanjing adults from eastern China between 2011 to 2017.
Data were collected from the Global Burden of Disease Study 2017. We conducted a comparative risk assessment analysis to estimate the IHD mortality and disability-adjusted life years (DALYs) attributable to one environmental, three behavioral, four metabolic, and 11 dietary risk factors in 2011 and 2017. The average exposure distributions were obtained from a systematic search of multiple databases. The means and 95% uncertainty intervals (UIs) were calculated and reported for IHD deaths, DALYs, and attributable to risk from 2011 and 2017.
The total IHD deaths in all ages increased between 2011 and 2017 in Nanjing, from 1747 (95%UI 1123–2371) to 2432 (95%UI 1839–3025) in men and 1866 (95%UI 1282–2450) to 2267 (95%UI 1702–2832) in women. IHD deaths accounted for 11.5% of all deaths in 2017, ranking only next to stroke (21.9%). Conversely, the age-standardized death rate of IHD decreased from 95.35 (95% UI 91.29–99.41) to 75.94 (95%UI 72.59–79.30) per 100,000 persons in men and from 79.85 (95%UI 76.11–83.59) to 56.10 (95%UI 53.26–58.94) per 100,000 persons in women. The four leading IHD risk factors for both mortality and DALY rates in 2017 were high systolic BP, high LDL-C, diet high in sodium, and diet low in fruits.
Population growth and aging led to a steady increase in IHD burden from 2011 to 2017. Dietary, behavioral, metabolic, and environmental risk factors account for most of the IHD burden, highlighting many opportunities for prevention.
... Smoking is one of the risk factors for stroke and poor prognosis [44,45]. In addition, the GBD Study 2017 estimated 380 million smokers in China [46]. "China Smoking Harmful Health Report 2020" showed that there were more than 300 million smokers in China in 2018, the smoking rate of people over 15 years old in China was 26.6%, and the smoking rate of males was 50.5%; more than 1 million people lose their lives to tobacco every year, and if no effective action is taken, it is expected to increase to 2 million per year by 2030 and 3 million per year by 2050 [47]. ...
Since 2015, stroke has become the leading cause of death and disability in China, posing a significant threat to the health of its citizens as a major chronic non-communicable disease. According to the China Stroke High-risk Population Screening and Intervention Program, an estimated 17.8 million [95% confidence interval (CI) 17.6-18.0 million] adults in China had experienced a stroke in 2020, with 3.4 million (95% CI 3.3-3.5 million) experiencing their first-ever stroke and another 2.3 million (95% CI 2.2-2.4 million) dying as a result. Additionally, approximately 12.5% (95% CI 12.4-12.5%) of stroke survivors were left disabled, as defined by a modified Rankin Scale score greater than 1, equating to 2.2 million (95% CI 2.1-2.2 million) stroke-related disabilities in 2020. As the population ages and the prevalence of risk factors like diabetes, hypertension, and hyperlipidemia continues to rise and remains poorly controlled, the burden of stroke in China is also increasing. A large national epidemiological survey initiated by the China Hypertension League in 2017 showed that the prevalence of hypertension was 24.7%; the awareness, treatment, and control rates in hypertensive patients were: 60.1%, 42.5%, and 25.4%, respectively. A nationally representative sample of the Chinese mainland population showed that the weighted prevalence of total diabetes diagnosed by the American Diabetes Association criteria was 12.8%, suggesting there are 120 million adults with diabetes in China, and the awareness, treatment, and control rates in diabetic patients were: 43.3%, 49.0%, and 49.4%, respectively. The "Sixth National Health Service Statistical Survey Report in 2018" showed that the proportion of the obese population in China was 37.4%, an increase of 7.2 points from 2013. Data from 1599 hospitals in the Hospital Quality Monitoring System and Bigdata Observatory Platform for Stroke of China (BOSC) showed that a total of 3,418,432 stroke cases [mean age ± standard error (SE) was (65.700 ± 0.006) years, and 59.1% were male] were admitted during 2020. Of those, over 80% (81.9%) were ischemic stroke (IS), 14.9% were intracerebral hemorrhage (ICH) strokes, and 3.1% were subarachnoid hemorrhage (SAH) strokes. The mean ± SE of hospitalization expenditures was Chinese Yuan (CNY) (16,975.6 ± 16.3), ranging from (13,310.1 ± 12.8) in IS to (81,369.8 ± 260.7) in SAH, and out-of-pocket expenses were (5788.9 ± 8.6), ranging from (4449.0 ± 6.6) in IS to (30,778.2 ± 156.8) in SAH. It was estimated that the medical cost of hospitalization for stroke in 2020 was CNY 58.0 billion, of which the patient pays approximately CNY 19.8 billion. In-hospital death/discharge against medical advice rate was 9.2% (95% CI 9.2-9.2%), ranging from 6.4% (95% CI 6.4-6.5%) for IS to 21.8% for ICH (95% CI 21.8-21.9%). From 2019 to 2020, the information about 188,648 patients with acute IS receiving intravenous thrombolytic therapy (IVT), 49,845 patients receiving mechanical thrombectomy (MT), and 14,087 patients receiving bridging (IVT + MT) were collected through BOSC. The incidence of intracranial hemorrhage during treatment was 3.2% (95% CI 3.2-3.3%), 7.7% (95% CI 7.5-8.0%), and 12.9% (95% CI 12.3-13.4%), respectively. And in-hospital death/discharge against medical advice rate was 8.9% (95% CI 8.8-9.0%), 16.5% (95% CI 16.2-16.9%), and 16.8% (95% CI 16.2-17.4%), respectively. A prospective nationwide hospital-based study was conducted at 231 stroke base hospitals (Level III) from 31 provinces in China through BOSC from January 2019 to December 2020 and 136,282 stroke patients were included and finished 12-month follow-up. Of those, over 86.9% were IS, 10.8% were ICH strokes, and 2.3% were SAH strokes. The disability rate [% (95% CI)] in survivors of stroke at 3-month and 12-month was 14.8% (95% CI 14.6-15.0%) and 14.0% (95% CI 13.8-14.2%), respectively. The mortality rate [% (95% CI)] of stroke at 3-month and 12-month was 4.2% (95% CI 4.1-4.3%) and 8.5% (95% CI 8.4-8.6%), respectively. The recurrence rate [% (95% CI)] of stroke at 3-month and 12-month was 3.6% (95% CI 3.5-3.7%) and 5.6% (95% CI 5.4-5.7%), respectively. The Healthy China 2030 Stroke Action Plan was launched as part of this review, and the above data provide valuable guidelines for future stroke prevention and treatment efforts in China.
... According to a report published by the Global Burden of Disease (GBD) 2015 Tobacco Collaborators (2017), approximately 6.4 million annual global deaths were attributed to smoking with more than 50% of the deaths occurring in China, India, the United States, and Russia. Furthermore, among Chinese males, tobacco-attributed death rates increased by 50% between 1990 and 2017 (Wen et al. 2020). Smoking kills approximately 1 million people annually in China, but this number is expected to reach around 3 million in 2050 if the Chinese central government does not introduce further intervention to combat smoking Xiao et al. 2015). ...
Background
China is a large country with substantial urban-rural disparity. With the increasing concerns related to the rapid growth of the older adult population and problems related to smoking and alcohol consumption, this study aims to examine the potential urban-rural disparity associated with nicotine or alcohol dependence among Chinese older adults.
Methods
We used three waves of the Chinese Longitudinal Healthy Longevity Survey and included older adults who were 65 years old or above (CLHLS; n = 18,207). The Heckman two-step selection procedure was applied to reduce potential selection bias. The first and the second steps of the Heckman two-step selection procedure all included multivariable logistic regressions.
Results
In the final study sample, approximately 8.1% and 4.0% of older adults reported nicotine and alcohol dependence, respectively. In the first step of the Heckman selection procedure, urban residents were less likely to become current smokers and alcohol users than rural residents (all p < .05). However, urban-rural disparity was not associated with either nicotine or alcohol dependence (all p > .05).
Conclusions
We did not observe the urban-rural disparity in nicotine and alcohol dependence among Chinese older adults. Chinese policymakers should continue to strengthen national policy to combat smoking and alcohol consumption, especially older adults.
... An exposure to household burning of solid fuels for heating might be responsible for some hotspots of lung cancer identified in the first survey such as in Xuanwei, Yunnan province [50]. According to the GBD study in 2017, the tobacco-attributable age-standardized death rates of tracheal, bronchus and lung cancer increased by above 45% either in females or in males from 1990 to 2017 [51,52]. In contrast, according to the recent Global Cancer Statistics in 2020, a continuously declining cancer burden has been reported in the United States, and lung cancer-related death has decreased by 41% from 1991 to 2019, due largely to the success of the smoking cessation campaign since 1965 [53]. ...
Background:
Over the past four decades, the Chinese government has conducted three surveys on the distribution of causes of death and built cancer registration. In order to shine a new light on better cancer prevention strategies in China, we evaluated the profile of cancer mortality over the forty years and analyzed the policies that have been implemented.
Methods:
We described spatial and temporal changes in both cancer mortality and the ranking of major cancer types in China based on the data collected from three national surveys during 1973-1975, 1990-1992, 2004-2005, and the latest cancer registration data published by National Central Cancer Registry of China. The mortality data were compared after conversion to age-standardized mortality rates based on the world standard population (Segi's population). The geographical distribution characteristics were explored by marking hot spots of different cancers on the map of China.
Results:
From 1973 to 2016, China witnessed an evident decrease in mortality rate of stomach, esophageal, and cervical cancer, while a gradual increase was recorded in lung, colorectal, and female breast cancer. A slight decrease of mortality rate has been observed in liver cancer since 2004. Lung and liver cancer, however, have become the top two leading causes of cancer death for the last twenty years. From the three national surveys, similar profiles of leading causes of cancer death were observed among both urban and rural areas. Lower mortality rates from esophageal and stomach cancer, however, have been demonstrated in urban than in rural areas. Rural areas had similar mortality rates of the five leading causes of cancer death with the small urban areas in 1973-1975. Additionally, rural areas in 2016 also had approximate mortality rates of the five leading causes with urban areas in 2004-2005. Moreover, stomach, esophageal, and liver cancer showed specific geographical distributions. Although mortality rates have decreased at most of the hotspots of these cancers, they were still higher than the national average levels during the same time periods.
Conclusions:
Building up a strong primary public health system especially among rural areas may be one critical step to reduce cancer burden in China.
