China Faces Health Crisis

Smoking will kill 100 million men in China--one in every three now younger than 30--by the time they reach middle or old age, according to two papers published in tomorrow's British Medical Journal. "This alarming study is a landmark in public health research," says Jeffrey Koplan, director of the Centers for Disease Control and Prevention in Atlanta. "These data portend the coming of a devastating epidemic to China in the 21st century."

The findings are the result of a long-term collaboration between the Chinese Academies of Preventative Medicine and Medical Sciences in Beijing, Oxford University, and Cornell University. After surveying the smoking habits of 1.25 million men in several Chinese cities and rural areas, the researchers found that smoking already causes about 750,000 deaths per year. The team interviewed the families of all men who had died in a sample of Chinese provinces to determine factors, including smoking, that may have contributed to their deaths. This death rate will probably rise to 3 million by the time young smokers reach middle and old age, the researchers estimate.

The health risks of smoking are not widely known among the Chinese population, which consumes one third of current global cigarette production. "A 1996 nationwide survey showed that two-thirds believe smoking does little or no harm," says epidemiologist Richard Peto of Oxford University. Only 4% of adults know that smoking can cause heart disease, he notes, and just 40% realize that smokers risk lung cancer.

Tobacco-related deaths will probably keep mounting, the researchers say. By the turn of the century, cigarettes will kill an annual 4 million people worldwide; half in rich countries and half in the developing world. If current smoking trends persist, the researchers predict this rate will rise to 10 million deaths per year in 2030, with 70% in poor countries. Many regions may soon get a better handle on this grim prospect: The team's survey of young people's smoking behavior and older people's causes of death are now being adopted by countries in Asia, Africa, Eastern Europe, and Latin America to study their own emerging tobacco epidemics.

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