Abstract
In 2018, there were more than 371 million cigarette smokers and 12. 6 million electronic cigarette users, with 340.2 million non-smokers exposed to secondhand smoke (SHS) in China, which resulted in heavy tobacco-attributable disease burden. According to the definition by the Global Burden of Disease Study 2017 (GBD 2017), tobacco is a level 2 risk factor that consists of three sublevel risk factors, namely, smoking, SHS, and chewing tobacco. In this study, we aimed to evaluate the trends in deaths and disability-adjusted life years (DALYs) attributable to tobacco, smoking, SHS, and chewing tobacco by sex in China from 1990 to 2017 and to explore the leading causes of tobacco-attributable deaths and DALYs using data from the GBD 2017. From 1990 to 2017, the tobacco-attributable death rates per 100,000 people decreased from 75.65 [95% uncertainty interval (95% UI) = 56.23–97.74] to 70.90 (95% UI = 59.67–83.72) in females and increased from 198.83 (95% UI = 181.39–217.47) to 292.39 (95% UI = 271.28–313.76) in males. From 1990 to 2017, the tobacco-attributable DALY rates decreased from 2209.11 (95% UI = 1678.63–2791.91) to 1489.05 (95% UI = 1237.65–1752.57) in females and increased from 5650.42 (95% UI = 5070.06–6264.39) to 6994.02 (95% UI = 6489.84–7558.41) in males. In 2017, the tobacco-attributable deaths in China were concentrated on chronic obstructive pulmonary disease, ischemic heart disease, lung cancer, and stroke. The focus of tobacco control for females was SHS in 1990, whereas smoking and SHS were equally important for tobacco control in females in 2017. Increasing tobacco taxes and prices may be the most effective and feasible measure to reduce tobacco-attributable disease burdens.
Highlights
According to the definition by the Global Burden of Disease Study 2017 (GBD 2017), tobacco is a level 2 risk factor that consists of three sublevel risk factors, namely, smoking, secondhand smoke (SHS), and chewing tobacco [1]
We explored the leading causes of deaths and disabilityadjusted life years (DALYs) attributable to tobacco in 1990 and 2017, which could improve the focus of our tobacco control program
In 1990, 438.38 (95% uncertainty interval (UI) = 325.87–566.41) thousand deaths in females and 1227.74 (95% UI = 1120.06–1342.83) thousand deaths in males could be attributed to tobacco
Summary
According to the definition by the Global Burden of Disease Study 2017 (GBD 2017), tobacco is a level 2 risk factor that consists of three sublevel risk factors, namely, smoking, secondhand smoke (SHS), and chewing tobacco [1]. Tobacco has long served as the largest preventable cause of death worldwide [2,3,4]. China has been the largest tobacco producer worldwide, Disease Burden From Tobacco in China with only 1% of cigarettes produced in China being exported and the rest being consumed domestically [5]. Tobacco is a crucial risk factor for the leading causes of death in China, such as chronic obstructive pulmonary disease (COPD), lung cancer, stroke, and ischemic heart disease (IHD) [8,9,10,11]. Given the large number of populations affected by tobacco and the heavy tobacco-attributable disease burdens in China, a comprehensive study of the tobacco-attributable disease burden is urgently needed
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