Researchers at Oxford University say the numbers suggest smoking will become one of the greatest killers in China over the next several years as more Chinese light up.
The study confirms that cigarettes are just as harmful to Far Eastern populations as they are in the West.
"Whenever one gets to a new culture or another ethnic group, it has to be proved all over again. There's always a possibility that there are genetic differences and there are different factors involved," said Dr. Michael Thun, head of epidemiology at the American Cancer Society, who was not involved in the study. "But the bottom line hasn't changed. It's just as deadly, it just kills you in a different way."
The study tracked deaths from tobacco in Hong Kong, where the population started smoking about 20 years earlier than the people of mainland China. It takes about 50 years for the full hazard of persistent smoking to emerge.
Researchers said the Hong Kong pattern is seen as foreshadowing that of China because the Hong Kong population was able to afford to smoke decades earlier than people on the mainland.
"It may well foreshadow what will happen among men throughout mainland China, and in other developing countries, over the next few decades," said the study, led by Oxford University epidemiologist Sir Richard Peto.
The study involved nearly all Chinese people in Hong Kong who died in 1998. The researchers noted the cause of death of 27,507 people.
For each of the dead, the researchers interviewed the person who came into the registry offie to report the death, usually a relative. The participants were asked to recall the lifestyle of the dead person, including what his smoking habits were 10 years earlier.
They were also questioned about the habits of a living relative, usually the dead person's spouse or another relative aged at least 60. The comparison group included 13,054 people.
The study found that one-quarter of all the deaths of Chinese people aged 35-69 in Hong Kong that year were attributable to tobacco.
Tobacco killed 2,534 of the 7,588 men in that age group who died that year, or 33 percent, and 169 out of the 3,341 women who died, or 5 percent.
"Two-thirds of all the young men in China, but, as yet, few of the young women, become smokers," said Peto, whose group is credited with confirming the link between smoking and lung cancer. "On present smoking patterns, about one-third of all the young men in China will eventually be killed by tobacco."
The trends mirror what occurred in the West years ago as smoking spread across the globe, with deaths increasing several decades after the main rise in smoking.
Among the dead men who smoked, half were killed by tobacco, the study said the same proportion as in the developed world.
However, in China, smoking causes many more deaths from chronic lung disease than lung cancer, the reverse of what happens in the West.
Smoking also was not strongly linked to heart disease in China, as it is in the West, but instead was linked to tuberculosis.
Scientists attribute the differences to the fact that smoking exacerbates diseases already common in a country.
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