Tobacco Use and Trends
- In 2022, an estimated 291.0 million people (279.2 million males and 11.6 million females) aged 15 years and older were tobacco product users in China. This positions the country as the 1st globally and the 1st in the WHO Western Pacific Region in terms of number of tobacco users.1,2
- For comparison, according to the Global Adult Tobacco Survey (GATS) in 2020, 25.8% of people (48.8% males and 2.3% females) aged 15 years and older were current tobacco users.
- Smokeless tobacco use is low in China, where 1.2% of people (2.2% males and 0.2% females) aged 15 years and over were current smokeless tobacco users in 2020.
- In 2021, 3.3% of youth (4.5% boys and 1.9% girls) aged 13-15 years were current cigarette smokers in China (Figure 1).
- Manufactured cigarettes account for 96.7% of tobacco consumption in China. From 2010 to 2022, the demand for cigarettes per capita decreased by 5.3%, from 86.6 packs/capita in 2010 to 82 packs/capita in 2022. (Euromonitor [accessed November 2023])
Nicotine Alternatives
Figure 1: Youth Current Cigarette and E-Cigarette Use, 2021
Source: WHO Report on the Global Tobacco Epidemic (2023)
Health and Economic Burden From Tobacco Use
- In 2021, it was estimated that tobacco was the 1st highest risk factor driving the most deaths and disability combined in China.
- Tobacco was responsible for an estimated 2.7 million deaths, which is about 34.6% of total deaths.
- Of tobacco-related deaths, 2.3 million or 86.4% were due to smoking, and 483.0 thousand or 18.1% were due to secondhand smoke.
- In 2021, the top 10 causes of the most deaths in China included Stroke ranking 1st, Ischemic Heart Disease (IHD) ranking 2nd, Chronic Obstructive Pulmonary Disease (COPD) ranking 3rd and Lung Cancer ranking 4th.
- Tobacco was responsible for an estimated 496.3 thousand or 27.7% of all IHD deaths, 510.2 thousand or 23.2% of all Stroke deaths, 544.6 thousand or 84.1% of all Lung Cancer deaths, and 636.7 thousand or 61.9% of all COPD deaths.
- In 2021, tobacco use caused an estimated loss of 62.7 million disability-adjusted life years (DALYs), which was about 32.3% of total DALYs. Tobacco accounted for 10.9 million DALYs for IHD, 12.4 million DALYs for Stroke, 12.6 million DALYs for Lung Cancer, and 11.6 million DALYs for COPD.
- 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.
Diverse 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 the China Tobacco Monopoly. In 2019, China banned online sales and advertising of e-cigarettes. In March 2022, the government released the Management Rules for E-cigarettes and Electronic Cigarette Mandatory National Standards.
- Domestic sale of flavored e-cigarettes is banned except for those with tobacco flavors.
- Nicotine must be extracted from tobacco, 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, the total tax share on the retail price of a pack of cigarettes was 52.2%.
- E-cigarettes are taxed based on an ad valorem rate. The tax rate is 36% at the production (import) stage and 11% at the wholesale stage.
Smoking and Advertising Bans3
- Weak smoking bans with moderate level of compliance, and moderate advertising bans with complete level of compliance were enforced in China in 2022.
- E-cigarettes are subject to similar restrictions covering all enclosed public places, (e.g., hospitals, restaurants, educational facilities, public transport).
Age Restrictions
- Tobacco products and e-cigarettes cannot be sold to individuals younger than 18 years of age.
Illicit Cigarette Trade
- Estimated figures suggest that illicit cigarette trade has been decreasing and has been kept below 10% over the years, with an estimated rate of 8.5% in 2008 versus 2.4% in 2022. (Euromonitor [accessed November 2023])
Tobacco Production and Diversification
- In 2022, China produced about 2.2 million tons of unmanufactured tobacco, accounting for approximately 37.9% of the global production of 5.8 million tons. This positioned China as the 1st largest tobacco producer in the world.
- Compared to 2010, when China produced about 3 million tons of unmanufactured tobacco, there was a 27.2% decrease by 2022.
- In 2022, China utilized approximately 1 million hectares of land for tobacco cultivation, reflecting a 25.3% decrease compared to 2010. (FAOSTAT [accessed January 2024])
