Trends of Smoking Prevalence and Implication for Chronic Diseases in China: Serial National Cross-Sectional Surveys

Background: China is the world's largest consumer of tobacco and bears huge smoking-related chronic disease burden. This is the first nationwide study to evaluate the trends of smoking prevalence and its implication on chronic diseases in the Chinese population. Methods: We collected data from serial cross-sectional National Health Service Surveys conducted in China in 2003, 2008 and 2013. Multistage stratified cluster sampling method was used in this survey. All members aged 15 or older in the selected households were eligible. We analysed the variation tendency of the smoking prevalence from 2003 to 2013 and further identified risk factors for smoking and assessed the association between smoking and chronic diseases by using multiple logistic regression. Findings: A total of 153450, 145223, 229676 individuals were interviewed and involved in the study in 2003, 2008, and 2013 respectively. The standardised smoking prevalence for the entire population was 26·0%, 24·9% and 25·2% in 2003, 2008, and 2013 respectively. It was 48·4%, 47·0%, 47·2% for male and 3·1%, 2·3%, 2·7% for female. The tendency of the smoking prevalence varied in different regions, and we identified four major patterns of trends. Although male smokers were predominant in China, the standardised smoking prevalence in females aged below forty increased by 60·0% from 1·0% in 2003 to 1·6% in 2013. Moreover, the smoking prevalence increased by 50·6% among adolescent smokers aged 15-24 from 8·3% in 2003 to 12·5% in 2013. Risk factors for adolescent smoking were alcohol consumption (OR 7·5, 95%CI 6·9-8·1), the number of elder smokers in the family (OR 1·9, 95%CI 1·8-1·9), and low level education (OR 1·3, 95%CI 1·2-1·4). Increased risks of chronic diseases were related to smoking (OR 1.06, 95%CI 1·03-1·08), and even higher risks were related to early smoking initiation and long-term smoking. Interpretation: The implementation of tobacco control policies in China was not efficient in reducing smoking prevalence, since China signed the WHO FCTC in 2003. The current vast and growing smoking-related chronic disease burden would further soar as China's population is rapidly aging. Addressing it must be a priority of policymakers in China. Preventing adolescents and females from smoking initiation and avoiding conflicts of interest would be much more productive strategies for reducing smoking-related chronic disease burden. Funding Statement: National Health Commission of the People's Republic of China. Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: The NHSSs were approved by the institutional review board of the Chinese National Bureau of Statistics. All respondents provided their consents to participate in the survey before the interview.