China ranks first in the world in many indicators, but the situation of tobacco control in China is not optimistic

The tobacco industry brings huge fiscal revenue to the country, but also brings huge direct and indirect burdens to the health of the people and the whole society. Today is World No Tobacco Day. Let's take a look at the current situation of smokers in the world and China through a recent study. The situation in China is not optimistic.

www.cityofpasadena.netAuthor | Dr. Tang Bo, Molecular BiologyIn the past 30 years, the number of deaths caused by smoking worldwide has exceeded 200 million, and the annual economic cost has exceeded 1 trillion US dollars. A recent study shows that global tobacco control measures have achieved remarkable results in the past 30 years. However, China ranks first in the world in many indicators such as the number of smokers, tobacco consumption, and the number of deaths caused by smoking. The decline in smoking rate is lower than the global average, and the situation of tobacco control is not optimistic. China's tobacco control is less effective than the global average. On May 27, 2021, hundreds of researchers from China, the United States, the United Kingdom, Japan and other countries formed the Global Burden of Disease 2019 Tobacco Collaboration Group and published the latest research results online in the top international medical journal The Lancet. By modeling various indicators related to smoking in 3,625 nationally representative surveys, the tobacco use rate and the burden of disease attributable to 204 countries and regions from 1990 to 2019 were evaluated by age and gender to more comprehensively assess the impact of smoking on health. The results show that China ranks first in the world in both the number of smokers and tobacco consumption. Globally, there were approximately 1.14 billion smokers in 2019, a significant increase from 990 million in 1990, mainly due to global population growth. In 2019, there were 341 million smokers in China, accounting for 30% of the world's smokers, ranking first in the world. In 2019, smokers worldwide consumed a total of 7.41 trillion cigarettes equivalent to tobacco, and Chinese smokers consumed approximately 2.72 trillion cigarette equivalents, accounting for more than one-third of the world's tobacco consumption, also ranking first in the world. Due to its large population, it is not surprising that China ranks first in the world in terms of the total number of deaths and absolute increase in deaths due to smoking. In 2019, approximately 7.69 million deaths worldwide were related to smoking, and another 200 million disability-adjusted life years lost were also attributed to tobacco, accounting for 13.6% and 7.9% of the global deaths and disability-adjusted life years lost, respectively. Between 1990 and 2019, the proportion of all-cause deaths caused by smoking in 68 countries around the world dropped significantly, 65 countries remained basically stable, and another 71 countries increased significantly. The number of deaths from smoking in China increased from 1.5 million in 1990 to 2.4 million in 2019. The number of deaths from smoking in 2019 was 2.4 times that of India, the second largest country, accounting for 31.2% of the world's total. China has also become the country with the largest absolute increase in deaths attributable to smoking in the past 30 years. However, the decline in China's smoking rate is significantly lower than the global average, indicating that my country's tobacco control results are not ideal. According to reports, the average smoking rate of men aged 15 and above in the world is 32.7%, and the average smoking rate of women is 6.6%, which is 27.5% and 37.7% lower than in 1990, respectively. This reflects that global tobacco control measures have achieved certain results in the past 30 years, among which Brazil's tobacco control results are the most significant, with both male and female smoking rates reduced by more than 70%. Among people aged 15 and over, the countries with the highest male smoking rates are mainly in Asia and Oceania, while the countries with the highest female smoking rates are mostly in Europe and Oceania. The ten countries with the largest number of smokers in 2019 accounted for nearly two-thirds of the world's smoking population, namely China, India, Indonesia, the United States, Russia, Bangladesh, Japan, Turkey, Vietnam and the Philippines. In 2019, the average smoking rate of men aged 15 and over in China was close to 50%, significantly higher than the global level, while the smoking rate for women was 3.5%, lower than the global average. In the past 30 years, the smoking rates of men and women in China have decreased by 20.9% and 18.2% respectively, and the effectiveness of tobacco control is significantly lower than the global average. The health and economic losses caused by tobacco are staggering. Previously, several large-scale long-term cohort studies in the UK and the United States showed that up to two-thirds of long-term smokers will eventually die from smoking-related diseases. According to a research report published in The Lancet in October 2020 by the Global Burden of Disease 2019 Risk Factor Collaboration, about 80% of those who died from smoking in 2019 were men, accounting for about 20% of all-cause deaths in men, ranking first among the 20 global male level 2 risk factors for death, while tobacco-related deaths in women accounted for slightly less than 6% of all-cause deaths in women, ranking sixth among the causes of death in women. In addition, tobacco is also the number one factor in disability-adjusted life-year loss in men and the seventh factor in the burden of non-fatal diseases in women.

Tobacco ranks first among the world's second-level risk factors for death (the figure shows the ranking of risk factors for male death) | GBD2019 Risk Factors Collaborators, 2020 According to statistics, there are as many as 36 health problems related to smoking, among which ischemic heart disease, chronic obstructive pulmonary disease, lung cancer and stroke have become the main health risks related to smoking. The sum of the deaths caused by these factors accounts for more than 70% of the total number of deaths due to smoking. Except for developed countries, ischemic heart disease is the main factor in death from smoking, but China is slightly different. According to the analysis of the 2017 Global Burden of Disease data by Wuhan University and Hubei Provincial Center for Disease Control and Prevention, the diseases that caused deaths from smoking in China in 2017 were mainly concentrated in chronic obstructive pulmonary disease, ischemic heart disease, lung cancer and stroke, which is basically the same as the data in 2019. Smoking has also caused a huge social burden. In the past 30 years, the global economic losses caused by smoking have exceeded 1 trillion US dollars each year, and China has also suffered huge losses. According to a study published in February 2021 by Chengdu University of Traditional Chinese Medicine and the University of California, San Diego, in 2015, China's medical expenditures attributable to smoking were approximately $45.28 billion, accounting for 7.2% of the country's total medical expenditures. According to a study published in April 2021 by the First Affiliated Hospital of Zhejiang University School of Medicine and other institutions, in 2017, China had 813,000 lung cancer cases, 692,000 lung cancer deaths, and more than 15 million disability-adjusted life years lost due to lung cancer, accounting for about 37% of the world's total, making it the world's largest country for lung cancer, among which smoking is the most important factor in lung cancer. According to a study jointly released by the National Cancer Center of Peking Union Medical College and the National Cancer Institute of the United States, the total economic losses caused by lung cancer in China in 2017 reached $25 billion, and are expected to reach $53.4 billion by 2030. Can China's tobacco control measures be more powerful? Since the adoption of the World Health Organization's Framework Convention on Tobacco Control in 2005, global tobacco control has achieved remarkable results. Since 2005, most countries have entered a period of rapid decline in smoking rates among people aged 15 and above. In addition to Brazil's 73.4% drop in smoking rates, Norway and Senegal's smoking rates have dropped by more than 50%, while Iceland, Denmark, Canada, Australia, Colombia and Costa Rica have also dropped by more than 45%. In contrast, China's smoking rate among people aged 15 and over has only dropped by 19.5%. According to a research report by the Global Burden of Disease 2019 Tobacco Collaboration Group, the number of deaths from smoking and the effectiveness of tobacco control are often related to the income of a country or region. Of the 7.69 million people who died from smoking worldwide in 2019, nearly 80% came from low- and middle-income countries or regions. Among the 73 countries or regions with a smoking rate of more than 20% in 2019, nearly 60% were low- and middle-income countries or regions. Among the 71 countries or regions where the proportion of all-cause deaths caused by smoking increased significantly in 2019, low- and middle-income countries or regions accounted for more than 90%. Obviously, due to the lucrative tobacco industry, most developing countries have a high degree of dependence on tobacco taxes, and it is difficult for governments in these countries to take more stringent measures to control tobacco. According to statistics from relevant departments, in 2020, my country's tobacco industry realized a total of 1.28 trillion yuan in industrial and commercial taxes and profits, and paid a total of 1.2 trillion yuan to the treasury, accounting for about 6.7% of the country's fiscal revenue. However, with the continued development of the economy, government decision-makers must deal with the contradiction between the short-term benefits brought by the tobacco industry and the long-term harm caused by tobacco to citizens' health and the national economy, and adopt tobacco control measures that are more beneficial to the future of the country, society and citizens. Tobacco brings national health risks, but also brings huge profits and taxes. | lungcancerjourney.com The Global Burden of Disease 2019 Tobacco Cooperation Group also complained that most countries have not done enough in tobacco control, and called on governments to take stronger and stricter tobacco control measures than existing policies, such as setting tobacco taxes, and reducing tobacco consumption by increasing the cost of tobacco purchases, which can not only increase the country's fiscal revenue, but also reduce the number of smokers. This is also one of the main measures for Brazil's great success in tobacco control. In short, tobacco control is a long and gradual process that requires the joint efforts of governments, citizens and various organizations. (Editor Gao Peiwen) References: [1] GBD 2019 Tobacco Collaborators. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributabledisease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet. 2021 May27:S0140-6736(21)01169-7.[2] Wen H, Xie C, Wang F, et al. Trends in Disease BurdenAttributable to Tobacco in China, 1990-2017: Findings From the Global Burden ofDisease Study 2017. Front Public Health. 2020; 8:237.[3] Jha P, Ramasundarahettige C, Landsman V, Rostron B, ThunM, Anderson RN, McAfee T, Peto R. 21st-century hazards of smoking and benefits of cessation in the United States. N Engl J Med. 2013; 368(4):341-50.[4] Deng Y, Peng L, Li N, et al. Tracheal, bronchus, and lung cancer burden and related risk factors in the United States and China. Am J Transl Res. 2021;13(4):1928-1951.[5] Huang S, Wei H, Yao T, Mao Z, Sun Q, Yang L. The impact of smoking on annual healthcare cost: an econometric model analysis in China,2015. BMC Health Serv Res. 2021; 21(1):187.The article is published by "China Science and Technology Press" (ID: cspbooks). Please indicate the source for reprinting.