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Original research
Smoking-related cancer death among men and women in an ageing society (China 2020–2040): a population-based modelling study
  1. Ning Li1,
  2. Peng Wu1,
  3. Zixing Wang1,
  4. Yubing Shen1,
  5. Luwen Zhang1,
  6. Fang Xue1,
  7. Wei Han1,
  8. Yali Chen1,
  9. Jin Du1,
  10. Yujie Zhao1,
  11. Cuihong Yang1,
  12. Yaoda Hu1,
  13. Wentao Gu1,
  14. Wangyue Chen1,
  15. Xiaobo Guo1,
  16. Boqi Liu2,
  17. Jingmei Jiang1,
  18. Ningzhi Xu3
  1. 1 Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
  2. 2 Department of Cancer Epidemiology, Cancer Institute & Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
  3. 3 Laboratory of Cell and Molecular Biology & State Key Laboratory of Molecular Oncology, Cancer Institute & Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
  1. Correspondence to Dr Jingmei Jiang, Department of Epidemiology and Biostatistics, Peking Union Medical College, Beijing, China; jingmeijiang{at}ibms.pumc.edu.cn; Professor Ningzhi Xu, Laboratory of Cell and Molecular Biology, Cancer Institute & Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China; xuningzhi{at}cicams.ac.cn

Abstract

Background China is experiencing a postpeak smoking epidemic with accelerating population ageing. Understanding the impacts of these factors on the future cancer burden has widespread implications.

Methods We developed predictive models to estimate smoking-related cancer deaths among men and women aged ≥35 years in China during 2020–2040. Data sources for model parameters included the United Nations World Population Prospects, China Death Surveillance Database, national adult tobacco surveys and the largest national survey of smoking and all causes of death to date. The main assumptions included stable sex-specific and age-specific cancer mortality rates and carcinogenic risks of smoking over time.

Results In a base-case scenario of continuing trends in current smoking prevalence (men: 57.4%–50.5%; women: 2.6%–2.1% during 2002–2018), the smoking-related cancer mortality rate with population ageing during 2020–2040 would rise by 44.0% (from 337.2/100 000 to 485.6/100 000) among men and 52.8% (from 157.3/100 000 to 240.4/100 000) among women; over 20 years, there would be 8.6 million excess deaths (0.5 million more considering former smoking), and a total of 117.3 million smoking-attributable years of life lost (110.3 million (94.0%) in men; 54.1 million (46.1%) in working-age (35–64 years) adults). An inflection point may occur in 2030 if smoking prevalence were reduced to 20% (Healthy China 2030 goal), and 1.4 million deaths would be averted relative to the base-case scenario if the trend were maintained through 2040.

Conclusions Coordinated efforts are urgently needed to curtail a rising tide of cancer deaths in China, with intensified tobacco control being key.

  • health services
  • prevention
  • public opinion
  • smoking caused disease
  • surveillance and monitoring

Data availability statement

Data are available on reasonable request. Data supporting this manuscript are available to anyone who wishes to access the data from correspondence to jingmeijiang@ibms.pumc.edu.cn on reasonable request, following publication.

https://doi.org/10.1136/tobaccocontrol-2020-056444

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    Data availability statement

    Data are available on reasonable request. Data supporting this manuscript are available to anyone who wishes to access the data from correspondence to jingmeijiang@ibms.pumc.edu.cn on reasonable request, following publication.

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    Footnotes

    • NL, PW, ZW and YS contributed equally.

    • Contributors NX, JJ, BL, FX and WH conceived and designed the study. YC, JD, YZ, CY and ZW searched the literature. NL, PW, YS and LZ conducted the data collection and analysis. JJ and BL had access to verified underlying data. PW, YS, LZ, YZ and YH contributed to the figures. NL, PW and ZW contributed to interpretation of the data and performed the writing and drafting of the manuscript. All authors critically revised the manuscript and have agreed to this submission.

    • Funding This study was supported by the CAMS Innovation Fund for Medical Sciences (grant number 2017-I2M-1-009).

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.