Early health effects of the emerging tobacco epidemic in China. A 16-year prospective study.
Chen ZM., Xu Z., Collins R., Li WX., Peto R.
CONTEXT: In recent decades, there has been a rapid and substantial increase in tobacco consumption in China, particularly by men, but little is known from local epidemiologic studies about the pattern of smoking-related deaths. OBJECTIVE: To assess the current health effects of cigarette smoking in Shanghai, China. DESIGN: Prospective observational study of mortality in relation to cigarette smoking. SETTING: Eleven factories in urban Shanghai. SUBJECTS: A total of 9351 adults (6494 men and 2857 women) aged 35 to 64 years at baseline survey during the 1970s. OUTCOME MEASURES: All-cause and cause-specific mortality. RESULTS: During an average follow-up of 16 years, 881 men and 207 women died. Among men, 61% had described themselves as current cigarette smokers at baseline, and their overall mortality was significantly greater than that of nonsmokers (relative risk [RR], 1.4; 95% confidence interval [CI], 1.2-1.7; P