Smoking-related Disease Burden And Smoking-attributable Burden Of Disease In Males In Xuanwei,Yunnan Province Between 1990 And 2016

Background:Xuanwei City is a region with highest lung cancer mortality in China.Previous studies have shown that indoor air pollution is the main reason for the high lung cancer mortality in Xuanwei City.Therefore,in the 1980s,the local government conducted the stove improvement project.Over time,the lagging effect of indoor air pollution gradually weakened,and the effect of smoking may be prominent.Our aim is to estimate the smoking-related disease burden and the disease burden in male attributable to smoking in Xuanwei City from 1990 to 2016 and thus provide evidence for government health policy decisions.And to explore the methodology of population attributable fractions estimation due to smoking.Method:Mortality data were from the 2nd&3rd National Retrospective Cause of Death Survey and Xuanwei Disease Surveillance Point System from 2011 onwards.Mortality rates and years of life lost(YLLs)for 17 smoking-related diseases were calculated by four time period,1990-92,2004-05,2011-13 and 2014-16.In order to get the disability-adjusted life-years(DALYs)of lung cancer in 2014-16,mortality-to-prevalence ratio(M/P)of lung cancer calculated from six towns of Xuanwei were adjusted by DisMod Ⅱ,then prevalence for other towns based on M/P were estimated.Two indirect methods for population attributable fractions(PAF)due to smoking,prevalence-based and smoking impact ratio-based(SIR),were compared.At last,the PAF calculation method from Global Burden of Diseases,Injuries,and Risk Factors Study(GBD)2015,which combined the above two methods,was used to estimate smoking-attributable disease burden among males in Xuanwei.Result:In 2014-16,the mortality rates of cardiovascular diseases,respiratory diseases and malignant tumors in Xuanwei City were 160.08,148.38 and 145.87 per 100000,respectively.Accordingly,YLLs were 45.0,33.6 and 60.8 thousand person-years,respectively.Since 1990,the death rates of cardiovascular diseases have shown a continuous upward trend,while respiratory diseases has shown downward trend.Except for cervical cancer,the mortality rate of various cancers mostly increased first,and began to decline after 2005.The trend of YLL rate is similar to the mortality rate.The prevalence of lung cancer in Xuanwei City in 2014-16 was 322.98 per100000.The average annual lung cancer YLLs and YLDs were 38.7 and 0.08 thousand person-years,respectively.The PAFs caused by smoking by the direct method,SIR-based method,and prevalence-based method for male lung cancer were 64.32%,61.98%,and 51.44%respectively.In 2014-16,in total,the male PAF caused by smoking in Xuanwei City was 24.36%,which caused 1482 deaths and 29.3 thousand person-years of lost.Smoking-attributable deaths due to lung cancer and chronic obstructive pulmonary disease(COPD)were the highest,567(38.24%)and 661(44.59%),respectively.Conclusion:In general,the male smoking PAF in Xuanwei City was higher than the national level,although the above results have certain limitations,we didn’t consider the competitive effect of indoor air pollution in smoking-attributable disease burden.However,the above results suggest that the local government should actively carry out tobacco control and accelerate the tobacco control legislation.SIR-based PAF is slightly higher than prevalence-based PAF in Xuanwei,further research should be conducted to explore the PAF calculation method.