"About two-thirds of young Chinese men become cigarette smokers, and most start before they are 20. Unless they stop, about half of them will eventually be killed by their habit," said the article`s co-author Zhengming Chen from Oxford University.
China consumes over a third of the world`s cigarettes, and has a sixth of the global smoking death toll.
"The annual number of deaths in China that are caused by tobacco will rise from about one million in 2010 to two million in 2030 and three million in 2050, unless there is widespread cessation," the researchers wrote.
"Widespread smoking cessation offers China one of the most effective, and cost-effective, strategies to avoid disability and premature death over the next few decades."
The 2010 death toll was made up of some 840,000 men and 130,000 women in China, which has a population of about 1.4 billion.
Smokers have about twice the mortality rate of people who never smoked, with a higher risk of lung cancer, stroke and heart attack.
The proportion of deaths attributed to smoking among Chinese men aged 40-79 has doubled from about 10 percent in the early 1990s to 20 percent today, said the researchers.
Women smoke less
Among city dwellers the figure was even higher -- a quarter of all male deaths, and rising.
"Conversely, the women of working age in China now smoke much less than the older generation," said a statement from The Lancet.
"About 10 percent of the women born in the 1930s smoked, but only about one percent of those born in the 1960s did so."
Less than one percent of deaths in women born since 1960 are due to tobacco, said the study.
The researchers relied on data drawn from two nationwide studies involving some 730,000 Chinese people in total.
The first study ran over several years in the 1990s, the second started in 2006 and continues today.
There were a few silver linings, the authors said -- including that the number of smokers who quit rose from three percent in 1991 to nine percent in 2006.
Those who stopped smoking before they developed any serious illness had a similar disease risk ten years later than people who never smoked.
Price is key
"With effective measures to accelerate cessation, the growing epidemic of premature death from tobacco can be halted and then reversed, as in other countries," said the study led by researchers from Oxford University, the Chinese Academy of Medical Sciences and the Chinese Centre for Disease Control and Prevention.
In a comment also carried by The Lancet, Jeffrey Koplan and Michael Eriksen of the Emory Global Health Institute in Atlanta pointed out that China was not only the world`s largest consumer of tobacco, but also the largest grower and cigarette manufacturer.
"Being a government monopoly, China Tobacco (the Chinese National Tobacco Corporation) provides over seven percent of the central government`s annual revenue through both taxes and net income," they wrote.
Oxford University`s Richard Peto, one of the study authors, said tobacco deaths in Western countries have been dropping for 20 years, partly because of stiff price rises.
"For China, a substantial increase in cigarette prices could save tens of millions of lives."
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