Tobacco—the growing epidemic

Article metrics


The largest study ever undertaken to examine the health effects of tobacco finds that there are already a million deaths a year from smoking in China, and it predicts large increases in mortality over the next few decades. This pattern is likely to be repeated in other developing countries.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1: For the one million people who died between 1986 and 1988 in 24 cities (filled circles on map) and in various rural areas of China (open circles), the disease that caused death was determined and the family was interviewed to discover what the deceased person had smoked.
Figure 2: Death rates at ages 35–69 from lung cancer in various parts of China: smokers versus non–smokers (1986–1988).


  1. 1

    Liu, B.Q. et al. Emerging tobacco hazards in China: 1. Retrospective proportional mortality study of one million deaths. Br.Med. J. 317 , 1411–1422 (1998).

  2. 2

    Niu, S.R. et al. Emerging tobacco hazards in China: 2. Early mortality results from a prospective study. Br.Med. J. 317, 1423–1424 (1998).

  3. 3

    Ad Hoc Committee on Health Research. Investing in health research and development. The World Health Organization, Geneva, Switzerland (1996).

  4. 4

    Peto, R., Lopez, A.D., Boreham, J., Thun, M. & Heath, C. Jr. Mortality from smoking in developed countries 1950–2000: Indirect estimates from national vital statistics. Oxford University Press (1994).

  5. 5

    Murray, C.J.L. & Lopez, A.D. (eds). In The global burden of disease . (Harvard School of Public Health, Boston, Massachusetts, 1996).

  6. 6

    Doll, R., Peto, R., Wheatley, K., Gray, R. & Sutherland, I. Mortality in relation to smoking: 40 years' observations on male British doctors. Br.Med. J. 309, 901–911 (1994).

  7. 7

    Thun, M.J. et al. Alcohol consumption and mortality among middle–aged and elderly U.S. adults. N. Engl. J. Med. 337, 1705–1714 (1997).

  8. 8

    U.S. Department of Health & Human Services. Reducing the health consequences of smoking: 25 years of progress. A Report of the Surgeon General. U.S. Department of Health & Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. DHHS Publication No. (CDC) 89–8411 (1989).

Download references


We thank the Chinese principal investigators1,2 and our funding organizations.

Author information

Rights and permissions

Reprints and Permissions

About this article

Further reading