Smoking May Kill One-Third Of Chinese Men

The studies, undertaken by Oxford University, the Chinese Academies of Preventive Medicine and of Medical Sciences in Beijing and Cornell University in the United States, are part of the largest investigation ever on the hazards of tobacco, involving 1.25 million people.

In data to be published tomorrow by the British Medical Journal, Britain's traditional outlet for top level medical research, the researchers say that at present, 12 percent of all adult male deaths and three percent of all adult female deaths in China are now caused by smoking. But this reflects past smoking habits.

If present smoking patterns continue, at least 100 million Chinese men under 29 years will be killed by tobacco-related disease in their middle or old age, the researchers predict.

Because the increase in smoking is relatively recent in China, the full effects will not be seen for several decades, explains Professor Richard Peto of the Radcliffe Infirmary in Oxford.

As yet, the increase is confined to men, while the number of Chinese women who smoke is fairly small and is falling. The reasons for this are not clear, but Dr. Hengming Chen of Oxford University suggested it could be due to China's recent history and social development.

In the first of the two studies researchers interviewed the families of one million people who had died in 24 cities and 74 rural counties to establish if those who died were smokers.

The second study, which is still under way, is looking at 250,000 men aged over 40 and is recording mortality and causes of death over a 30-year period through annual monitoring.

The study takes into account diet, blood pressure, drinking and other factors. After five years, the findings reinforce those in the retrospective study -- that tobacco kills half of all smokers.

The results show that some 2,000 people a day are currently dying of smoking in China and by 2050, the researchers expect this number will rise to 8,000 a day or 3 million people a year.

Smoking causes a high number of heart-related deaths in the West, but in China the pattern is different.

"In the West, cigarettes cause lots of heart attack deaths, while in China smoking causes unexpectedly large numbers of deaths from tuberculosis, emphysema, stomach cancer and liver cancer," Dr Alan Lopez of the World Health Organization, told a news conference in London November 19, where the results were presented.

Men aged 35 to 69 were 51 percent were found to be more likely to die from cancer, 31 percent more likely to die from respiratory disease and 15 percent more likely to die of vascular diseases.

Of the Chinese deaths now being caused by tobacco, some 45 percent are from chronic lung disease, 15 percent from lung cancer and 5-8 percent each from esophageal cancer, liver cancer, stomach cancer, stroke, heart disease and TB.

Two-thirds of Chinese people think smoking does little or no harm and two thirds of men begin smoking before they are 25.

Nearly three-quarters of all Chinese men are smokers. Professor Richard Peto said that if cigarette consumption could be halved by 2020, 25 million deaths could be prevented in the first quarter of the 21st century.

"People thought that smoking was not going to cause very many deaths in poor countries like China. In retrospect it is just that they have not been smoking long enough. If they start smoking young and keep on smoking then about half the smokers are going to be killed by it," Dr. Chen explained.

"I spent ages in the 1980s saying that smoking is really dangerous. People thought I was exaggerating, but in fact it is about twice as bad as I was saying it was going to be."

According to the Journal, Jeffrey Koplan, director of the Centers for Disease Control and Prevention, said the tragedy was that the deaths are "entirely preventable."

Smokers are also switching increasingly to cigarettes from traditional methods of smoking such as pipes which have lower death rates.

"China still has a long way to go to educate the public about the risks of smoking," he said.

He notes, however, that although Chinese health officials support efforts to reduce tobacco consumption, treasury officials might find it difficult to forego the huge revenues generated in tax from the cigarette industry.

Chris Procter, head of science at British American Tobacco, said the study shows "what we have known for 50 years, that there are clearly risks associated with smoking."

However, he denies that Western companies are responsible for the increased cigarettes consumption in China. "Some 98 percent of all cigarettes made and sold in China are made and sold by the Chinese government," he pointed out.

The results of the studies have a wider significance than China, according to Dr Lopez. "These two new studies provide the first nationwide evidence of tobacco's effects in a developing country," he said. "The hazards are already substantial, and they cannot be limited to China."

Worldwide, by the turn of the century, cigarettes will already be causing about four million deaths a year, half in the rich countries and half in the poor countries.

But if current smoking patterns persist, then by about 2030 this will have risen to 10 million deaths a year, 70 percent of them in the developing world.