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Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies

Summary Background Chinese men now smoke more than a third of the world's cigarettes, following a large increase in urban then rural usage. Conversely, Chinese women now smoke far less than in previous generations. We assess the oppositely changing effects of tobacco on male and female mortality. Me... Full description

Journal Title: The Lancet 2015, Vol.386 (10002), p.1447-1456
Main Author: Chen, Zhengming, Prof
Other Authors: Peto, Richard, Prof , Zhou, Maigeng, MSc , Iona, Andri, MSc , Smith, Margaret, PhD , Yang, Ling, PhD , Guo, Yu, MSc , Chen, Yiping, DPhil , Bian, Zheng, MSc , Lancaster, Garry, MA , Sherliker, Paul, BA , Pang, Shutao, MSc , Wang, Hao, MSc , Su, Hua, MD , Wu, Ming, PhD , Wu, Xianping, MSc , Chen, Junshi, Prof , Collins, Rory, Prof , Li, Liming, Prof
Format: Electronic Article Electronic Article
Language: English
Subjects:
Men
Quelle: Alma/SFX Local Collection
Publisher: England: Elsevier Ltd
ID: ISSN: 0140-6736
Link: https://www.ncbi.nlm.nih.gov/pubmed/26466050
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title: Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies
format: Article
creator:
  • Chen, Zhengming, Prof
  • Peto, Richard, Prof
  • Zhou, Maigeng, MSc
  • Iona, Andri, MSc
  • Smith, Margaret, PhD
  • Yang, Ling, PhD
  • Guo, Yu, MSc
  • Chen, Yiping, DPhil
  • Bian, Zheng, MSc
  • Lancaster, Garry, MA
  • Sherliker, Paul, BA
  • Pang, Shutao, MSc
  • Wang, Hao, MSc
  • Su, Hua, MD
  • Wu, Ming, PhD
  • Wu, Xianping, MSc
  • Chen, Junshi, Prof
  • Collins, Rory, Prof
  • Li, Liming, Prof
subjects:
  • Adult
  • Age Distribution
  • Aged
  • Analysis
  • Articles
  • China
  • China - epidemiology
  • Chronic obstructive pulmonary disease
  • Cigarettes
  • Female
  • Follow-Up Studies
  • Humans
  • Internal Medicine
  • Male
  • Medicine(all)
  • Men
  • Middle Aged
  • Mortality
  • Mortality - trends
  • Prospective Studies
  • Rural areas
  • Rural Health - statistics & numerical data
  • Sex Distribution
  • Smoking
  • Smoking - mortality
  • Smoking Cessation - statistics & numerical data
  • Studies
  • Tobacco
  • Trends
  • Urban Health - statistics & numerical data
  • Women
ispartof: The Lancet, 2015, Vol.386 (10002), p.1447-1456
description: Summary Background Chinese men now smoke more than a third of the world's cigarettes, following a large increase in urban then rural usage. Conversely, Chinese women now smoke far less than in previous generations. We assess the oppositely changing effects of tobacco on male and female mortality. Methods Two nationwide prospective studies 15 years apart recruited 220 000 men in about 1991 at ages 40–79 years (first study) and 210 000 men and 300 000 women in about 2006 at ages 35–74 years (second study), with follow-up during 1991–99 (mid-year 1995) and 2006–14 (mid-year 2010), respectively. Cox regression yielded sex-specific adjusted mortality rate ratios (RRs) comparing smokers (including any who had stopped because of illness, but not the other ex-smokers, who are described as having stopped by choice) versus never-smokers. Findings Two-thirds of the men smoked; there was little dependence of male smoking prevalence on age, but many smokers had not smoked cigarettes throughout adult life. Comparing men born before and since 1950, in the older generation, the age at which smoking had started was later and, particularly in rural areas, lifelong exclusive cigarette use was less common than in the younger generation. Comparing male mortality RRs in the first study (mid-year 1995) versus those in the second study (mid-year 2010), the proportional excess risk among smokers (RR-1) approximately doubled over this 15-year period (urban: RR 1·32 [95% CI 1·24–1·41] vs 1·65 [1·53–1·79]; rural: RR 1·13 [1·09–1·17] vs 1·22 [1·16–1·29]), as did the smoking-attributed fraction of deaths at ages 40–79 years (urban: 17% vs 26%; rural: 9% vs 14%). In the second study, urban male smokers who had started before age 20 years (which is now typical among both urban and rural young men) had twice the never-smoker mortality rate (RR 1·98, 1·79–2·19, approaching Western RRs), with substantial excess mortality from chronic obstructive pulmonary disease (COPD RR 9·09, 5·11–16·15), lung cancer (RR 3·78, 2·78–5·14), and ischaemic stroke or ischaemic heart disease (combined RR 2·03, 1·66–2·47). Ex-smokers who had stopped by choice (only 3% of ever-smokers in 1991, but 9% in 2006) had little smoking-attributed risk more than 10 years after stopping. Among Chinese women, however, there has been a tenfold intergenerational reduction in smoking uptake rates. In the second study, among women born in the 1930s, 1940s, 1950s, and since 1960 the proportions who had smoked were, respectively,
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
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  • 0140-6736
  • 1474-547X
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titleContrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies
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creatorChen, Zhengming, Prof ; Peto, Richard, Prof ; Zhou, Maigeng, MSc ; Iona, Andri, MSc ; Smith, Margaret, PhD ; Yang, Ling, PhD ; Guo, Yu, MSc ; Chen, Yiping, DPhil ; Bian, Zheng, MSc ; Lancaster, Garry, MA ; Sherliker, Paul, BA ; Pang, Shutao, MSc ; Wang, Hao, MSc ; Su, Hua, MD ; Wu, Ming, PhD ; Wu, Xianping, MSc ; Chen, Junshi, Prof ; Collins, Rory, Prof ; Li, Liming, Prof
creatorcontribChen, Zhengming, Prof ; Peto, Richard, Prof ; Zhou, Maigeng, MSc ; Iona, Andri, MSc ; Smith, Margaret, PhD ; Yang, Ling, PhD ; Guo, Yu, MSc ; Chen, Yiping, DPhil ; Bian, Zheng, MSc ; Lancaster, Garry, MA ; Sherliker, Paul, BA ; Pang, Shutao, MSc ; Wang, Hao, MSc ; Su, Hua, MD ; Wu, Ming, PhD ; Wu, Xianping, MSc ; Chen, Junshi, Prof ; Collins, Rory, Prof ; Li, Liming, Prof ; China Kadoorie Biobank (CKB) collaborative group
descriptionSummary Background Chinese men now smoke more than a third of the world's cigarettes, following a large increase in urban then rural usage. Conversely, Chinese women now smoke far less than in previous generations. We assess the oppositely changing effects of tobacco on male and female mortality. Methods Two nationwide prospective studies 15 years apart recruited 220 000 men in about 1991 at ages 40–79 years (first study) and 210 000 men and 300 000 women in about 2006 at ages 35–74 years (second study), with follow-up during 1991–99 (mid-year 1995) and 2006–14 (mid-year 2010), respectively. Cox regression yielded sex-specific adjusted mortality rate ratios (RRs) comparing smokers (including any who had stopped because of illness, but not the other ex-smokers, who are described as having stopped by choice) versus never-smokers. Findings Two-thirds of the men smoked; there was little dependence of male smoking prevalence on age, but many smokers had not smoked cigarettes throughout adult life. Comparing men born before and since 1950, in the older generation, the age at which smoking had started was later and, particularly in rural areas, lifelong exclusive cigarette use was less common than in the younger generation. Comparing male mortality RRs in the first study (mid-year 1995) versus those in the second study (mid-year 2010), the proportional excess risk among smokers (RR-1) approximately doubled over this 15-year period (urban: RR 1·32 [95% CI 1·24–1·41] vs 1·65 [1·53–1·79]; rural: RR 1·13 [1·09–1·17] vs 1·22 [1·16–1·29]), as did the smoking-attributed fraction of deaths at ages 40–79 years (urban: 17% vs 26%; rural: 9% vs 14%). In the second study, urban male smokers who had started before age 20 years (which is now typical among both urban and rural young men) had twice the never-smoker mortality rate (RR 1·98, 1·79–2·19, approaching Western RRs), with substantial excess mortality from chronic obstructive pulmonary disease (COPD RR 9·09, 5·11–16·15), lung cancer (RR 3·78, 2·78–5·14), and ischaemic stroke or ischaemic heart disease (combined RR 2·03, 1·66–2·47). Ex-smokers who had stopped by choice (only 3% of ever-smokers in 1991, but 9% in 2006) had little smoking-attributed risk more than 10 years after stopping. Among Chinese women, however, there has been a tenfold intergenerational reduction in smoking uptake rates. In the second study, among women born in the 1930s, 1940s, 1950s, and since 1960 the proportions who had smoked were, respectively, 10%, 5%, 2%, and 1% (3097/30 943, 3265/62 246, 2339/97 344, and 1068/111 933). The smoker versus non-smoker RR of 1·51 (1·40–1·63) for all female mortality at ages 40–79 years accounted for 5%, 3%, 1%, and <1%, respectively, of all the female deaths in these four successive birth cohorts. In 2010, smoking caused about 1 million (840 000 male, 130 000 female) deaths in China. Interpretation Smoking will cause about 20% of all adult male deaths in China during the 2010s. The tobacco-attributed proportion is increasing in men, but low, and decreasing, in women. Although overall adult mortality rates are falling, as the adult population of China grows and the proportion of male deaths due to smoking increases, the annual number of deaths in China that are caused by tobacco will rise from about 1 million in 2010 to 2 million in 2030 and 3 million in 2050, unless there is widespread cessation. Funding Wellcome Trust, MRC, BHF, CR-UK, Kadoorie Charitable Foundation, Chinese MoST and NSFC
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0ISSN: 0140-6736
1EISSN: 1474-547X
2DOI: 10.1016/S0140-6736(15)00340-2
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languageeng
publisherEngland: Elsevier Ltd
subjectAdult ; Age Distribution ; Aged ; Analysis ; Articles ; China ; China - epidemiology ; Chronic obstructive pulmonary disease ; Cigarettes ; Female ; Follow-Up Studies ; Humans ; Internal Medicine ; Male ; Medicine(all) ; Men ; Middle Aged ; Mortality ; Mortality - trends ; Prospective Studies ; Rural areas ; Rural Health - statistics & numerical data ; Sex Distribution ; Smoking ; Smoking - mortality ; Smoking Cessation - statistics & numerical data ; Studies ; Tobacco ; Trends ; Urban Health - statistics & numerical data ; Women
ispartofThe Lancet, 2015, Vol.386 (10002), p.1447-1456
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0Chen et al. Open Access article distributed under the terms of CC BY
12015 Chen et al. Open Access article distributed under the terms of CC BY
2Copyright © 2015 Chen et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.
3COPYRIGHT 2015 Elsevier B.V.
4Copyright Elsevier Limited Oct 10, 2015
52015 Chen et al. Open Access article distributed under the terms of CC BY 2015
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descriptionSummary Background Chinese men now smoke more than a third of the world's cigarettes, following a large increase in urban then rural usage. Conversely, Chinese women now smoke far less than in previous generations. We assess the oppositely changing effects of tobacco on male and female mortality. Methods Two nationwide prospective studies 15 years apart recruited 220 000 men in about 1991 at ages 40–79 years (first study) and 210 000 men and 300 000 women in about 2006 at ages 35–74 years (second study), with follow-up during 1991–99 (mid-year 1995) and 2006–14 (mid-year 2010), respectively. Cox regression yielded sex-specific adjusted mortality rate ratios (RRs) comparing smokers (including any who had stopped because of illness, but not the other ex-smokers, who are described as having stopped by choice) versus never-smokers. Findings Two-thirds of the men smoked; there was little dependence of male smoking prevalence on age, but many smokers had not smoked cigarettes throughout adult life. Comparing men born before and since 1950, in the older generation, the age at which smoking had started was later and, particularly in rural areas, lifelong exclusive cigarette use was less common than in the younger generation. Comparing male mortality RRs in the first study (mid-year 1995) versus those in the second study (mid-year 2010), the proportional excess risk among smokers (RR-1) approximately doubled over this 15-year period (urban: RR 1·32 [95% CI 1·24–1·41] vs 1·65 [1·53–1·79]; rural: RR 1·13 [1·09–1·17] vs 1·22 [1·16–1·29]), as did the smoking-attributed fraction of deaths at ages 40–79 years (urban: 17% vs 26%; rural: 9% vs 14%). In the second study, urban male smokers who had started before age 20 years (which is now typical among both urban and rural young men) had twice the never-smoker mortality rate (RR 1·98, 1·79–2·19, approaching Western RRs), with substantial excess mortality from chronic obstructive pulmonary disease (COPD RR 9·09, 5·11–16·15), lung cancer (RR 3·78, 2·78–5·14), and ischaemic stroke or ischaemic heart disease (combined RR 2·03, 1·66–2·47). Ex-smokers who had stopped by choice (only 3% of ever-smokers in 1991, but 9% in 2006) had little smoking-attributed risk more than 10 years after stopping. Among Chinese women, however, there has been a tenfold intergenerational reduction in smoking uptake rates. In the second study, among women born in the 1930s, 1940s, 1950s, and since 1960 the proportions who had smoked were, respectively, 10%, 5%, 2%, and 1% (3097/30 943, 3265/62 246, 2339/97 344, and 1068/111 933). The smoker versus non-smoker RR of 1·51 (1·40–1·63) for all female mortality at ages 40–79 years accounted for 5%, 3%, 1%, and <1%, respectively, of all the female deaths in these four successive birth cohorts. In 2010, smoking caused about 1 million (840 000 male, 130 000 female) deaths in China. Interpretation Smoking will cause about 20% of all adult male deaths in China during the 2010s. The tobacco-attributed proportion is increasing in men, but low, and decreasing, in women. Although overall adult mortality rates are falling, as the adult population of China grows and the proportion of male deaths due to smoking increases, the annual number of deaths in China that are caused by tobacco will rise from about 1 million in 2010 to 2 million in 2030 and 3 million in 2050, unless there is widespread cessation. Funding Wellcome Trust, MRC, BHF, CR-UK, Kadoorie Charitable Foundation, Chinese MoST and NSFC
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titleContrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies
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2Zhou, Maigeng, MSc
3Iona, Andri, MSc
4Smith, Margaret, PhD
5Yang, Ling, PhD
6Guo, Yu, MSc
7Chen, Yiping, DPhil
8Bian, Zheng, MSc
9Lancaster, Garry, MA
10Sherliker, Paul, BA
11Pang, Shutao, MSc
12Wang, Hao, MSc
13Su, Hua, MD
14Wu, Ming, PhD
15Wu, Xianping, MSc
16Chen, Junshi, Prof
17Collins, Rory, Prof
18Li, Liming, Prof
aucorpChina Kadoorie Biobank (CKB) collaborative group
formatjournal
genrearticle
ristypeJOUR
atitleContrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies
jtitleThe Lancet
addtitleLancet
date2015
risdate2015
volume386
issue10002
spage1447
epage1456
pages1447-1456
issn0140-6736
eissn1474-547X
codenLANCAO
notesMembers listed at end of the report
abstractSummary Background Chinese men now smoke more than a third of the world's cigarettes, following a large increase in urban then rural usage. Conversely, Chinese women now smoke far less than in previous generations. We assess the oppositely changing effects of tobacco on male and female mortality. Methods Two nationwide prospective studies 15 years apart recruited 220 000 men in about 1991 at ages 40–79 years (first study) and 210 000 men and 300 000 women in about 2006 at ages 35–74 years (second study), with follow-up during 1991–99 (mid-year 1995) and 2006–14 (mid-year 2010), respectively. Cox regression yielded sex-specific adjusted mortality rate ratios (RRs) comparing smokers (including any who had stopped because of illness, but not the other ex-smokers, who are described as having stopped by choice) versus never-smokers. Findings Two-thirds of the men smoked; there was little dependence of male smoking prevalence on age, but many smokers had not smoked cigarettes throughout adult life. Comparing men born before and since 1950, in the older generation, the age at which smoking had started was later and, particularly in rural areas, lifelong exclusive cigarette use was less common than in the younger generation. Comparing male mortality RRs in the first study (mid-year 1995) versus those in the second study (mid-year 2010), the proportional excess risk among smokers (RR-1) approximately doubled over this 15-year period (urban: RR 1·32 [95% CI 1·24–1·41] vs 1·65 [1·53–1·79]; rural: RR 1·13 [1·09–1·17] vs 1·22 [1·16–1·29]), as did the smoking-attributed fraction of deaths at ages 40–79 years (urban: 17% vs 26%; rural: 9% vs 14%). In the second study, urban male smokers who had started before age 20 years (which is now typical among both urban and rural young men) had twice the never-smoker mortality rate (RR 1·98, 1·79–2·19, approaching Western RRs), with substantial excess mortality from chronic obstructive pulmonary disease (COPD RR 9·09, 5·11–16·15), lung cancer (RR 3·78, 2·78–5·14), and ischaemic stroke or ischaemic heart disease (combined RR 2·03, 1·66–2·47). Ex-smokers who had stopped by choice (only 3% of ever-smokers in 1991, but 9% in 2006) had little smoking-attributed risk more than 10 years after stopping. Among Chinese women, however, there has been a tenfold intergenerational reduction in smoking uptake rates. In the second study, among women born in the 1930s, 1940s, 1950s, and since 1960 the proportions who had smoked were, respectively, 10%, 5%, 2%, and 1% (3097/30 943, 3265/62 246, 2339/97 344, and 1068/111 933). The smoker versus non-smoker RR of 1·51 (1·40–1·63) for all female mortality at ages 40–79 years accounted for 5%, 3%, 1%, and <1%, respectively, of all the female deaths in these four successive birth cohorts. In 2010, smoking caused about 1 million (840 000 male, 130 000 female) deaths in China. Interpretation Smoking will cause about 20% of all adult male deaths in China during the 2010s. The tobacco-attributed proportion is increasing in men, but low, and decreasing, in women. Although overall adult mortality rates are falling, as the adult population of China grows and the proportion of male deaths due to smoking increases, the annual number of deaths in China that are caused by tobacco will rise from about 1 million in 2010 to 2 million in 2030 and 3 million in 2050, unless there is widespread cessation. Funding Wellcome Trust, MRC, BHF, CR-UK, Kadoorie Charitable Foundation, Chinese MoST and NSFC
copEngland
pubElsevier Ltd
pmid26466050
doi10.1016/S0140-6736(15)00340-2
oafree_for_read