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Provincial-level cancer burden attributable to active and second-hand smoking in China
  1. Changfa Xia1,
  2. Rongshou Zheng1,
  3. Hongmei Zeng1,
  4. Maigeng Zhou2,
  5. Lijun Wang2,
  6. Siwei Zhang1,
  7. Xiaonong Zou1,
  8. Kexin Sun1,
  9. Zhixun Yang1,
  10. He Li1,
  11. Mark Parascandola3,
  12. Farhad Islami4,
  13. Wanqing Chen1
  1. 1 National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  2. 2 National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
  3. 3 Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
  4. 4 Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia, USA
  1. Correspondence to Professor Wanqing Chen, National Cancer Center, Beijing 100021, China; chenwq{at}


Background Understanding disparities in the burden of cancer attributable to smoking is crucial to inform and improve tobacco control measures. In this report, we estimate the population attributable fraction (PAF) of cancers deaths attributable to smoking at the national and provincial levels in China.

Methods Using cancer mortality data from 978 counties, smoking data from a nationwide survey and relative risks from a prospective study of 0.5 million adults in China, we calculated the absolute (non-standardised) and standardised numbers and proportions of cancer deaths among adults 30 years and older attributable to active and second-hand smoking in 2014 across all 31 provinces in Mainland China.

Results The estimated number of cancer deaths attributable to smoking in China in 2014 was 342 854 among men and 40 313 among women, of which second-hand smoking accounted for 1.8% and 50.0%, respectively. Among men, the absolute PAF in China was 23.8%, ranging from 14.6% in Xinjiang to 26.8% in Tianjin; the overall standardised PAF was 22.2%, ranging from 15.7% in Xinjiang to 26.0% in Guizhou. Among women, the overall absolute and standardised PAFs were 4.8% and 4.0%, ranging from 1.8% and 1.6% in Jiangxi to 14.9% and 9.6% in Heilongjiang, respectively. Overall, provinces with the highest standardised PAFs among men were located in Southwest China and among women in the Northeast.

Conclusions Comprehensive smoke-free policies in China should expand to all provinces, notably those with a higher burden of cancer attributable to smoking, instead of being mostly limited to Beijing and some other metropolitan areas.

  • smoking caused disease
  • disparities
  • public policy
  • carcinogens
  • secondhand smoke

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  • Contributors WC conceived and designed the study. CX led the data analysis, wrote the first draft and drafted the final manuscript. RZ, MZ and LW did the cancer data abstraction, collecting, cleaning, checking and coding. MZ and SZ oversaw data collection and quality control. HZ, XZ and KS contributed to manuscript amendments and abstraction of smoking data. FI and MP contributed to the development of analysis plans, reviewed the results and contributed to the preparation of the final manuscript. ZY and HL checked the analysis process and reviewed results. All authors contributed to the interpretation of data and approved the final manuscript.

  • Funding This study was supported by the Ministry of Science and Technology of China (grant number 2014FY121100).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.