Province-specific smoking-attributable cancer mortality in China 2013

Linjie Yu; Junxia Cheng; Xiaoli Cui; Jianbing Wang

doi:10.18332/tid/122013

Province-specific smoking-attributable cancer mortality in China 2013

Tob Induc Dis. 2020 Jun 1:18:49. doi: 10.18332/tid/122013. eCollection 2020.

Authors

Linjie Yu¹, Junxia Cheng¹, Xiaoli Cui², Jianbing Wang³

Affiliations

¹ Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, People's Republic of China.
² Department of Gynecologic Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, People's Republic of China.
³ Department of Epidemiology and Biostatistics, The Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.

Abstract

Introduction: Province-specific initiatives are at the forefront of tobacco control but limited studies have provided province-specific assessment of smoking-attributable cancer burden in China.

Methods: We estimated the fraction of total and site-specific cancer mortality attributable to tobacco smoking in 31 provinces in mainland China. The population attributable fractions (PAFs) for cancer deaths due to smoking were calculated by Levin's formula using province-specific smoking prevalence data around 1998 (assuming a 15-year latency time) and relative risks from cohort studies and meta-analyses. The 95% confidence intervals (CIs) of PAFs were calculated by a Delta method. Cancer deaths were abstracted from cancer registry data of the 31 provinces in mainland China in 2013.

Results: Overall, smoking contributed to a total of 421566 cancer deaths in mainland China in 2013 (19.46% of all cancer deaths), with 400701 of these deaths occurring in men (29.34%) and 20865 (2.61%) in women. The population attributable fractions ranged from 15.56% (95% CI: 9.12-21.82%) in Tibet to 35.09% (95% CI: 25.68-45.83%) in Guizhou among men, and from 0.28% (95% CI: 0.00-0.64%) in Hainan to 10.44% (95% CI: 4.86-16.32%) in Jilin among women. Cancers of lung and liver were the two main smoking-attributable cancers for both men and women.

Conclusions: Tobacco smoking was responsible for nearly 20% of all cancer deaths in mainland China, but the proportion of cancer deaths attributable to smoking varied substantially across provinces. More effective programs and innovative new strategies for local tobacco control are warranted to reduce the future burden of smoking-related cancers in all provinces of mainland China.

Keywords: China; cancer; population attributable fraction; smoking.