state of smoking and health in China

This page was last edited on: March 21, 2024 at 3:52 pm

Smoking Rate

24.8% (2022)

tobacco use rate

24.9% (2022)

Tobacco Use and Trends

In 2022, an estimated 291 million [1] adults aged 15 years and older in China are tobacco product users. This positions China as the 1st globally and the WHO Western Pacific Region (WRP) in terms of the number of tobacco product users.
Smokeless tobacco use is low in China where 1.2% of adults (2.2% male and 0.2% female) aged 15 years and over were current users in 2020.
Smoking prevalence among adults is higher in western and middle provinces, in rural areas, and among those with middle school education.
Smoking prevalence is the highest among farmers (30.6%) and commerce industry workers (30.6%) and the lowest among teachers (9.8%) and doctors (14.2%).
In 2021 3.3% of youth (4.5% boys and 1.9% girls) aged between 13 and 15 years old were current cigarette smokers in China (Figure 1).
Manufactured cigarettes account for 96.7% of tobacco consumption in China. The demand for cigarettes per capita is estimated to fall by 5.3% from 86.6/packs/capita in 2010 to 82 packs/capita in 2022.

Nicotine Alternatives

In 2020, 0.7% of adults (1.2% male and 0.1% female) aged 15 years and over were current e-cigarette users.
In 2021 3.1% of youth (3.9% boys and 2.2% girls) were current e-cigarette users (Figure 1)

Health and Economic Burden From Tobacco Use

In 2019, it is estimated that tobacco is the 1^st highest risk factor that drives the most death and disability combined in China.
It accounts for more than 2.7 million deaths, which is 37% of total deaths in 2019.
- Of tobacco deaths, 89.4% was due to smoking and 15.4% from secondhand smoke.
Stroke, Ischemic heart disease (IHD), COPD, and Lung Cancer are the top 4 causes of death and disabilities combined respectively where tobacco is responsible for 495 thousand or 29% of total IHD deaths, 614.4 thousand or 71% of all COPD deaths, and 468 thousand or 25% of all Stroke deaths in 2019.
Tobacco use causes an estimated loss of 64.1 million disability-adjusted life years (DALYs) – 34% of total DALY where tobacco accounts for the loss of 11.5 million DALYs for IHD, 11.4 million DALYs for tracheal/bronchus/lung cancer, 11.5 million DALYs for COPD and 11.7 million DALYs for Stroke.
In 2014, the direct cost of treating tobacco-related illness caused a substantial economic burden, totaling an estimated USD 9 billion, accounting for 1.5% of the total national health expenditure. The overall economic burden from tobacco use in 2014 is estimated at USD 57 billion.

regulatory environment and economics

Public Health Commitment

China ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2005.

Diversity of Tobacco Market

In 2022, China classifies heated tobacco products (HTPs) and e-cigarettes as “tobacco”, and includes under the regulation of cigarettes but has not authorized the sale of HTPs on the market.
E-cigarettes are legally available and regulated by China Tobacco Monopoly. In 2019, China banned online sales and advertising of e-cigarettes. In March, the government released the Management Rules for E-cigarettes, which take effect starting May 1, 2020.
Domestic sales of flavored e-cigarettes are banned except for tobacco flavors
Nicotine has to be extracted from tobacco and the nicotine concentration of e-cigarettes is limited to 20mg/ml and nicotine in e-liquids should be 99% pure.
E-cigarettes also display text health warnings, covering 35% of both sides of packages.

Taxation Policy

In 2022, total tax share on the retail price of a pack of cigarettes was 52.2%.
E-cigarettes are taxed 36% for producers and importers (presumably based on producers’ price and CIF value respectively) who are brand owners, and 11% for distributors.

Smoking and Advertising Bans

Minimum comprehensive smoking bans, with a moderate compliance level and slightly less than comprehensive advertising bans with complete compliance are enforced in 2022.
E-cigarettes are subject to similar restrictions covering all closed public places, (e.g., hospitals, restaurants), educational facilities, public transport).

age restrictions

Tobacco products and e-cigarettes cannot be sold those individuals younger than 18 years of age.

illicit cigarette trade

Estimated figures suggest that illicit cigarette trade has been kept below 10% over the years with 8.5% in 2008 and declining to 2.4% in 2022.

TOBACCO PRODUCTION AND DIVERSIFICATION

In 2022, China was the largest unmanufactured tobacco producer in the globe, producing approximately 2.2 million tons which accounts for 37.9% of the global production of 5.8 million tons. This marks a significant shift from the 3 million tons produced in 2010. China reduced the total production by 27% in 2022.
Furthermore, China utilized an estimated 1 million hectares of land to harvest tobacco in 2022, which is 25.3% less than 2010. Source: FAOSTAT

As research findings become available that are inclusive of additional gender identities, the Foundation will update the information presented.

[1] ESTIMATED NUMBER OF TOBACCO USERS

Source: World Health Organization: Non-age-standardized estimates of current tobacco use, tobacco smoking and cigarette smoking (Tobacco control: Monitor) and The World Bank’s Population Estimates and Projections.

Explanation: This estimate is calculated by applying the WHO’s estimated percentage of tobacco smokers for 2023 to the World Bank’s projected population figures of the same year for 15 years and older. These figures should be used with caution, as they do not account for the 95% credible interval around the estimate.