CONTROLLING SMOKING-RELATED DISEASES IN CHINA: USE OF A SIMULATION MODEL TO PROJECT THE IMPACT OF HEALTH POLICY INTERVENTIONS
Method(s): We built the China LCPM using a well-established lung cancer microsimulation model. The China LCPM can project population outcomes associated with health interventions for smoking-related diseases in China. Smoking intensity and cessation rates from literature were used as model inputs. Model outputs were then calibrated to match smoking prevalence estimates from the China Health and Nutrition Survey (CHNS) and Chinese lung cancer mortality rates from the International Agency for Research on Cancer (IARC). Using the calibrated model, we estimated deaths attributable to smoking if intensive tobacco control measures and CT-based lung cancer screening were implemented from 2016-2050 in China. We defined an “intensive” tobacco control program as a program which could double the current, low smoking cessation rate of 2-3% per year. For lung cancer screening, we adapted eligibility criteria established by the U.S. Centers for Medicare & Medicaid Services.
Result(s): By 2050, we projected that an intensive tobacco control program would prevent approximately 0.9 million lung cancer deaths, 1.5 million other smoking-attributable deaths, and 43.6 million life-years lost in China. CT-based lung cancer screening in China would prevent an additional 1.2 million lung cancer deaths and 16.9 million life-years lost. The China LCPM estimated that males will contribute 74% of the lung cancer death burden in 2015. A program combining tobacco control and screening would reduce the cumulative lung cancer deaths between 2016- 2050 by 14.3%; for females, this value is projected to be 5.7%.
Conclusion(s): More than half of males in China are current smokers. Evidence from western countries tells us that an unprecedented number of smoking-attributable deaths will occur as the Chinese population ages. In China, a combination of intensive tobacco control measures and CT-based lung cancer screening, beginning in 2016, would prevent 3.6 million smoking-attributable deaths, including 2.1 million lung cancer deaths, by 2050. Effective health policies to mitigate the substantial disease burden caused by smoking in China may have a substantial, future public health impact. Our China LCPM is a comprehensive simulation platform that can provide instrumental information to policy makers about smoking-related diseases.