Many millions of deaths from chronic obstructive pulmonary disease (COPD), lung cancer, and tuberculosis could be averted in China if smoking and biomass and coal fuel use in homes were phased out over the next 25 years. These are the conclusions of authors of an Article published early Online and in an upcoming edition of The Lancet.
The three diseases above are three of the ten leading causes of death in China, where prevalences of smoking and solid fuel use are also high. Drs Hsien-Ho Lin and Majid Ezzati, Harvard School of Public Health, Boston, MA, USA, and colleagues, modeled the effects of these risk factor trends on these diseases. They found that if smoking and biomass and coal burning remain at current levels, then the period 2003-2033 would see an estimated 65 million deaths from COPD and 18 million deaths from lung cancer. The combined effects of smoking and biomass and coal use will be responsible for 82% of COPD deaths and 75% of lung cancer deaths. Gradual elimination of smoking and solid fuel use by 2033 could avoid 26 million deaths from COPD and 6.3 million deaths from lung cancer. Moderate-aggressive interventions (ie, significant progress but not complete phase out of smoking/solid fuel use) would reduce COPD deaths by 6-31% and lung cancer deaths by 8-26%.
Eliminating or reducing smoking and biomass and coal fuels by 2033 would also reduce the projected annual tuberculosis incidence, with the reduction dependent on the effectiveness/coverage of the DOTS (directly observed treatment, short-course) treatment programme that is the cornerstone of tuberculosis control in China. The more effective this DOTS programme is, the lower the relative effect of any smoking/solid fuel reduction would be. The authors estimate that projected annual tuberculosis incidence in 2033 would be lower by 14-52% if 80% DOTS coverage is sustained, 27-62% if 50% coverage is sustained, or 33-71% if 20% coverage is sustained.
The authors conclude: "Reductions in smoking and solid fuel use can significantly reduce the burden of COPD and lung cancer. Moderate, aggressive, and complete reduction of these exposures over the next three decades, through mechanisms such as tobacco taxation, advertising ban, and fuel pricing, can lead to a 7-38% reduction in deaths from these diseases, which have few other effective treatments."
In an accompanying Comment, Dr Gong-huan Yang, Centre for Disease Control and Prevention, Beijing, China, and Dr Nan-shan Zhong, Gangzhou Medical College, China, say: "[This] study is a good reminder for the Chinese Government to make relevant policies and emphasises the urgent need for tobacco control and expedition of gas fuel as a replacement for solid fuel in China."
See also Viewpoint on COPD published at same time as these papers.
Dr Majid Ezzati, Harvard School of Public Health, Boston, MA, USA T) please complete telephone number E) majid_ezzati@harvard.edu
Dr Nan-shan Zhong, Gangzhou Medical College, China T) +86-13609003622 E) nanshan@vip.163.com
Full Article and Comment: http://press.thelancet.com/COPDchinafinal.pdf
Journal
The Lancet