Economic burden of smoking-attributable diseases in China: A systematic review
Lili Shi 1, 2
Lumin Zhong 3, 2
Yuyang Cai 2, 4  
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Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Department of Epidemiology and Public Health, University College London, London, United Kingdom
NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
Yuyang Cai   

School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, 200025 Shanghai, China
Publication date: 2020-05-12
Tob. Induc. Dis. 2020;18(May):42
This review aims to synthesise the studies on smoking-attributable burden of diseases in China to assess the economic burden of smoking and highlight the weakness in these studies to inform future studies.

A systematic search of studies on smoking-attributable burden of disease in seven databases was conducted in 2019 and studies were screened according to inclusion and exclusion criteria. The evaluation of studies was based on the seven key elements for burden of disease studies. Costs were converted into 2013 Renminbi (RMB), with 1000 RMB about 163 US$ in 2013, the year of the first search, using the Consumer Price Index and the then exchange rate.

Twenty studies were identified that estimated the costs of smoking in China, ranging from 57.162 to 368.273 billion RMB in total. The largest proportion of direct costs was allocated to outpatient visits, accounting for 49.17–68.94% of the direct costs. Meanwhile, costs resulting from mortality constituted 64.52–98.82% of the indirect costs. In mainland China, the understanding of PAR% (ratio of population attributable risk and incidence in the total population) in studies is not consistent. Studies on the cost of passive smoking are lacking and the research method for diseases needs to be improved.

Smoking-attributable diseases have exerted substantial direct and indirect economic burden on China. The methodologies for future studies should be improved. Hong Kong and Taiwan provide good examples for future research in mainland China and researchers there should use PAR% correctly. More studies on the burden of passive smoking should be conducted. We propose a combination of single and all-disease research methods, if data are sufficient.

We thank the team members for their support and contributions to this study.
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
This work was supported by the National Social Science Foundation of China (Grant No. 17BSH056), and the open project of NHC Key Laboratory of Health Economics and Policy Research (NHCHEPR2018005).
Not commissioned; externally peer reviewed.
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