Trends in Disease Burden Attributable to Tobacco in China, 1990–2017: Findings From the Global Burden of Disease Study 2017

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.

Financial Literacy, Financial Education, and Smoking Behavior: Evidence From Japan

“…For the demographic variables, we find that being male, older (until a certain age), divorced, and having an education level below university degree, low household income, and low household assets are related to the current smoking status. Our results are consistent with those of previous studies, which found that smoking is more prevalent and progressive in males [e.g., ( 13 , 73 – 78 )] and persons in lower socioeconomic status (SES) [e.g., ( 73 , 79 – 85 )]. A plausible explanation is that persons in higher SES groups tend to have more knowledge about health risks and better access to health care resources and smoking cessation services ( 79 , 84 ), which results in a lower rate of smoking prevalence compared to those in the lower SES group.…”

“…Smoking has substantially negative health [e.g., ( 7 – 13 )], behavioral [e.g., ( 14 – 16 )], and economic consequences [e.g., ( 17 , 18 )]. One important question is why do many people still engage in smoking despite its harmful effects.…”

Smoking Behaviour of University Students: a Descriptive Study

“…It should also be noted that the prevalence of tobacco use among adults has decreased in recent years, but tobacco consumption among teenagers and young adults tends to remain high (Jayawardhana et al, 2019). Another study, which was conducted in China and focused on the effect of smoking-related diseases, showed a significant decrease in the prevalence of smoking observed from 1990 to 2017 in both males and females, while confirming the long lagged effect of smoking and deaths, as the smoking-related death rates showed an increasing trend in both sexes during the study period (Wen et al, 2020). In general, smoking remains a major public health concern, as it is a leading cause of death and morbidity in almost every country (Ng et al, 2014;Braillon, 2017).…”

“…But there is a new phenomenon called e-cigarette smoking; the study of Azagba et al, (2020) showed that the use of electronic cigarettes among young people increased significantly from 2014 to 2018. For example, in 2018 in China, there were more than 371 million cigarette smokers and 12.6 million electronic cigarette users (Wen et al, 2020). Electronic cigarettes may have offset conventional smoking among adolescents and young adults by maintaining the total prevalence of nicotine use and diverting them from more harmful conventional smoking.…”

“…To reduce the prevalence of smoking requires multiple efforts and active steps that lead to improved smoking-related health education, an anti-cigarette trend, free access to smoking cessation counselling, and the implementation of regulations and restrictions on tobacco advertising, promotion, and sponsorship (Wen et al, 2020). For example, the findings provided by Septiono et al (2020) showed that there may be an association between the adoption of local smokefree policies and decreased intensity of smoking.…”