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October 4th, 2008:

Millions To Die In China From Lung Disease: Report

Reporting by Tan Ee Lyn; Editing by Jerry Norton – Reuters | Sat Oct 4, 2008

HONG KONG (Reuters) – Tens of millions of people will die from respiratory illness and lung cancer over the next 25 years in China if nothing is done to reduce smoking and fuel burning indoors, scientists warned.

In an article published in The Lancet, they predicted 65 million deaths from chronic obstructive pulmonary disease (COPD) and 18 million deaths from lung cancer between 2003 and 2033 from smoking and biomass burning at home.

Those figures would account for 19 and 5 percent respectively of all deaths in China during that period, said the researchers at the Harvard School of Public Health (HSPH).

However, interventions to reduce smoking and household use of biomass — like wood, charcoal, crop residues and dung — for cooking and heating could reduce the number of deaths.

Using mathematical models, they said gradual elimination of smoking and biomass burning would avoid 26 million deaths from COPD and 6.3 million deaths from lung cancer by 2033.

Interventions include building proper chimneys, air circular stoves with chimneys ending outside the house and ventilated ground stoves to cut respirable particulates, carbon dioxide and sulphur dioxide circulating indoors.

“There are proven ways to reduce tobacco smoking and to provide homes with clean-burning energy alternatives. China can save millions of premature deaths from respiratory diseases in the next few decades if it … implements these interventions,” said Majid Ezzati, associate professor of international health at HSPH and senior author of the study.

Respiratory diseases are among the 10 leading causes of deaths in China. About half of Chinese men smoke and in more than 70 percent of homes, Chinese cook and heat their homes with wood, coal and crop residues.

Smoking and pollution from indoor burning of these fuels are major risk factors for COPD and lung cancer and have been linked to tuberculosis.

Globally, more than 900 million of the world’s 1.1 billion smokers currently live in low-income and middle-income countries and about one half of the world’s population uses biomass and coal for household energy.

© Thomson Reuters 2008 All rights reserved.

30-year Smoke Toll Put At 63m

Agence France-Presse – Updated on Oct 04, 2008

Tobacco use and smoke from coal and wood are likely to claim tens of millions of lives in China in the next quarter-century, according to a study published online today by the British journal The Lancet.

Smoke from tobacco, biomass and coal will kill 53.3 million Chinese people from chronic respiratory illnesses and 13.5 million from lung cancer from 2003 to 2033, its authors calculate, using the current rate of exposure as a benchmark.

Half of Chinese men smoke, and more than 70 per cent of Chinese households use solid fuels – such as wood, crop residue and coal – for heating and cooking, providing a potent source of indoor air pollution, the study says.

Smoke from these sources will account for 82 per cent of the likely 65 million deaths in China from respiratory disease from 2003 to 2033, and 75 per cent of the probable 18 million deaths from lung cancer, it projects.

The lead authors of the paper were Hsien-Ho Lin and Majid Ezzati of the Harvard School of Public Health in Massachusetts.

Effects Of Smoking And Solid-fuel Use On Health In China

Hsien-Ho LinMD, Megan MurrayMD, Ted CohenMD, Caroline ColijnPhD and Majid EzzatiPhD – The Lancet DOI:10.1016/S0140-6736(08)61345-8 |

Title: Effects of smoking and solid-fuel use on COPD, lung cancer, and tuberculosis in China: a time-based, multiple risk factor, modelling study



Chronic obstructive pulmonary disease (COPD), lung cancer, and tuberculosis are three leading causes of death in China, where prevalences of smoking and solid-fuel use are also high. We aimed to predict the effects of risk-factor trends on COPD, lung cancer, and tuberculosis.


We used representative data sources to estimate past trends in smoking and household solid-fuel use and to construct a range of future scenarios. We obtained the aetiological effects of risk factors on diseases from meta-analyses of epidemiological studies and from large studies in China. We modelled future COPD and lung cancer mortality and tuberculosis incidence, taking into account the accumulation of hazardous effects of risk factors on COPD and lung cancer over time, and dependency of the risk of tuberculosis infection on the prevalence of disease. We quantified the sensitivity of our results to methods and data choices.


If smoking and solid-fuel use remain at current levels between 2003 and 2033, 65 million deaths from COPD and 18 million deaths from lung cancer are predicted in China; 82% of COPD deaths and 75% of lung cancer deaths will be attributable to the combined effects of smoking and solid-fuel use. Complete gradual cessation of smoking and solid-fuel use by 2033 could avoid 26 million deaths from COPD and 6·3 million deaths from lung cancer; interventions of intermediate magnitude would reduce deaths by 6–31% (COPD) and 8–26% (lung cancer). Complete cessation of smoking and solid-fuel use by 2033 would reduce the projected annual tuberculosis incidence in 2033 by 14–52% if 80% DOTS coverage is sustained, 27–62% if 50% coverage is sustained, or 33–71% if 20% coverage is sustained.


Reducing smoking and solid-fuel use can substantially lower predictions of COPD and lung cancer burden and would contribute to effective tuberculosis control in China.


International Union Against Tuberculosis and Lung Disease.


a. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
b. Department of Population and International Health, Harvard School of Public Health, Boston, MA, USA
c. Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
d. Community Health Society, Mennonite Christian Hospital, Hualien, Taiwan
e. Division of Infectious Disease, Massachusetts General Hospital, Boston, USA
f. Division of Social Medicine and Health Inequalities, Brigham and Women’s Hospital, Boston, USA
g. Department of Engineering Mathematics, University of Bristol, Bristol, UK
h. Initiative for Global Health, Harvard University, Cambridge, MA, USA

Corresponding Author InformationCorrespondence to: Majid Ezzati, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA