Huge Toll From Smoking Is Rising Among Chinese

In an alarming confirmation of the toll taken by tobacco in the world’s most populous country, researchers have found that smoking causes more than 700,000 deaths annually in China--a rate of 2,000 deaths every day, most of them men in the prime of life.

If current smoking patterns continue, tobacco will claim 8,000 lives a day here within half a century, a report published in today’s issue of the British Medical Journal predicts. At least one-third--or 100 million--of the young men now under 30 will die because of their nicotine habit, half of them before reaching their 70th birthday, the study predicted.

The study, which its authors call the largest of its kind ever undertaken, with a staggering sample size of 1 million, provides a grim survey of the ravages of smoking in the world’s largest cigarette market. It comes as tobacco companies in the United States sign a deal to pay $206 billion to states that had sued them over spiraling medical bills and economic losses.

The new figures are certain to add fuel to the fight against smoking in China, a relatively new entrant to the fray and now the target of global anti-tobacco forces.

“This is the first step of a long march,” declared Chen Zhengming, an epidemiology researcher at Oxford University and one of the principal authors of the study.

The report demonstrates just how monumental a task public-health experts face in a land where three out of four men light up. By contrast, smoking among women has decreased in China in recent years and is now virtually nonexistent in comparison--about 1%, say researchers, who can’t explain the drop.

Beyond the personal willpower of smokers, eliminating smoking will also require huge political and economic will from the Communist government because 90% of all domestic cigarette manufacturers enjoy some form of state backing.

One-third of all cigarettes smoked in the world today are smoked in China, for a staggering total of 1.8 trillion a year--the equivalent of a pack a day for every man, woman and child in the United States.

Smoking is China’s leading cause of death, a spot that it is likely to occupy for decades. The upward curve echoes the deadly trend in the United States, where 400,000 people now die every year from tobacco-related causes out of a population of 260 million.

Average daily consumption went from one per Chinese man in 1952 to four in 1972 and 10 in 1992. By comparison, Americans smoked one cigarette per adult daily in 1910, four in 1930 and 10 in 1950. Now an estimated 47 million American adults smoke cigarettes, according to the federal Centers for Disease Control and Prevention.

“Already, about one in eight male deaths [in China] is caused by smoking,” said Niu Shiru, a professor at the Chinese Academy of Preventive Medicine and a contributor to the study. “By 2050, it will be one in three.”

If current trends continue, experts predict that in 2050, smoking will be responsible for nearly 3 million deaths a year in China, or about three-quarters of the entire worldwide total today.

But in a curious finding, the new study--funded by the Chinese government, the World Bank, British medical agencies and the U.S. National Institutes of Health--discovered that the incidence of smoking-related diseases in China differs from that in the West.

For reasons that remain unclear, more Chinese smokers tend to die of chronic respiratory diseases rather than of lung cancer, the most prevalent cause of death related to tobacco consumption in the U.S.

A surprising number of Chinese men who smoked also succumbed to tuberculosis, researchers found in interviews conducted around 1990 with the families of about 1 million people who had died across the country. The researchers, from Oxford and Cornell universities and two Chinese medical academies, said it took eight years to analyze and release their data because of the sample’s size.

Although other lung diseases are more common, lung cancer still plagues smokers far more than those who stay away from nicotine--three times as often, for example, among urban smokers between the ages of 35 and 69 as among abstainers.

To prevent an even more calamitous epidemic of smoking-related illnesses and deaths, health officials are directing their education efforts at the young, mindful that two-thirds of Chinese men pick up the habit before turning 25. Officials are also trying to figure out ways to help inveterate inhalers quit.

“The good news is that stopping smoking is really worthwhile,” said Richard Peto, a researcher at Oxford. “If smokers stop before they have cancer or some other serious disease, they avoid most of the risk of death from tobacco. If they don’t, there is a 50-50 chance of being killed by tobacco.”

Gao Shanwu, 26, tried his first cigarette as a 14-year-old and was up to more than a pack a day a few years ago. He has since moderated slightly--now it takes him two or three days to go through a pack--but kicking the habit altogether seems impossible.

“I know how harmful smoking is. I want to stop, but I can’t control myself,” said Gao, who works in a flower shop. “I tried to quit smoking several times, but I failed. Now I just smoke less.”

Health officials may face an even more difficult task in swaying people like Gao’s older brother, Shanming, who does not recognize the habit as a particularly hazardous one. “I only smoke half a pack of cigarettes a week,” he said. “I don’t think it’s very detrimental to my health.”

In a nationwide survey two years ago, two-thirds of respondents said they believed that smoking caused little to no harm. There is also a widespread perception that “smoking kills Western people, not Chinese,” said Chen, the Oxford researcher.

Another obstacle confronting any campaign against smoking is the role tobacco plays in the economy.

Nine out of 10 cigarette manufacturers in China are owned or supported by the state. Yunnan, a poor province in China’s southwest, derives 75% of its income from tobacco crops, a provincial spokesman said.

“It’s up to the policymakers to decide what to do based on the evidence,” Chen said. “It’s not possible to close all the [cigarette] manufacturers. If there’s demand, then there will be supply. This is a market economy.”

The key, he added, is reducing demand.

Some local authorities have taken small steps, such as banning cigarette advertising and smoking in public places. Beijing’s prestigious Qinghua University is about to become the country’s first smoke-free campus--excluding medical schools.

International groups have made China a target of their anti-tobacco efforts, including the World Health Organization, whose director general, Gro Harlem Brundtland, is scheduled to arrive today on a trip that will include attending a seminar here in the Chinese capital on anti-smoking efforts.