Emerging tobacco hazards in China: 2. Early mortality results from a prospective study

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Abstract
Objective: To monitor the evolving epidemic of mortality from tobacco in China following the large increase in male cigarette use in recent decades. Design: Prospective study of smoking and mortality starting with 224 500 interviewees who should eventually be followed for some decades. Setting: 45 nationally representative small urban or rural areas distributed across China. Subjects: Male population aged 40 or over in 1991, of whom about 80% were interviewed about smoking, drinking, and medical history. Main outcome measure: Cause specific mortality, initially to 1995 but later to continue, with smoker versus non-smoker risk ratios standardised for area, age, and use of alcohol. Results: 74% were smokers (73% current, only 1% former), but few of this generation would have smoked substantial numbers of cigarettes since early adult life. Overall mortality is increased among smokers (risk ratio 1.19; 95% confidence interval 1.13 to 1.25, PConclusion: This prospective study and the accompanying retrospective study show that by 1990 smoking was already causing about 12% of Chinese male mortality in middle age. This proportion is predicted to rise to about 33% by 2030. Long term continuation of the prospective study (with periodic resurveys) can monitor the evolution of this epidemic.