Hong Kong tobacco deaths presage vast China epidemic
A huge epidemic of smoking-related deaths is forecast for China, whose inhabitants account for 20% of the world's population and smoke 30% of the world's cigarettes. A study carried out in Hong Kong and reported in the 18 August British Medical Journal suggests that estimated deaths in China caused by smoking could rise from the current 1 million a year to about 3 million a year during the 2040s. In Hong Kong, cigarette consumption peaked in the early 1970s ¾ about 20 years earlier than in mainland China.
Sir Richard Peto, co-director of the Clinical Trials Service Unit at the University of Oxford and one of the authors of the study, told the Bulletin: "The results of this study make it clear that Chinese populations can have substantial proportions of deaths caused by tobacco. Yet going back to the 1980s, there was a general conviction in China that cigarette smoking was not a serious health problem." As recently as 1997, he said, a survey presented to the 10th World Conference on Tobacco or Health held that year in Beijing had found that 96% of Chinese adults in the general population did not know that smoking could cause heart disease, and 60% did not know that smoking could cause lung cancer.
The Hong Kong study was carried out by Professor Lam Tai Hing of the University of Hong Kong, together with colleagues in Hong Kong, and Peto. It was based on records and verbal accounts of more than 27 000 ethnic Chinese, aged 35 and over, whose deaths were registered in Hong Kong in 1998. Using a questionnaire completed usually by the person reporting the death, the researchers sought information about the cause of death and the dead person's lifestyle, including information on his or her smoking habits 10 years before death (before illness could have modified the person's smoking habits). These details were compared with those of living controls of the same age.
Analysis of the Hong Kong data showed that tobacco caused about 33% of all male deaths at ages 35¾69, plus 5% of all female deaths ¾ in other words, 25% of all deaths at these ages. For comparison, in the European Union, the proportion of deaths caused by smoking among adults aged 35¾69 years in 1995 was estimated to be 32% for males and 10% for females, according to updated figures from a study published by Peto and co-workers in 1994 (Mortality from smoking in developed countries, 1950¾2000, New York, Oxford University Press, 1994).
Unless many adult smokers in China give up the habit, Peto said, deaths there from smoking could triple from the current level to 3 million a year during the 2040s and could total 100 million between now and 2050. Some of this rise would be due to population growth in China and some would be due to "maturation" of the epidemic of smoking-related deaths. As long, though, as China remains the largest market for cigarettes in the world, with about 60% of males addicted to the habit, its chances of avoiding the impending epidemic of smoking deaths are certainly slim. 
Sharon Kingman, London, UK
