What is the clinical evidence from this study?

Study design: Observational. Population: Ischemic heart disease (n=16578). Intervention: Former smoking vs. Never smoking. Primary outcome: Heart disease diagnosis (AOR 1.84, 95% CI 1.50-2.25, p=<0.001).

What question did this study set out to answer?

This research aims to assess the burden of smoking-attributable ischemic heart disease in China and project future trends by gender.

March 25, 2026Tobacco Induced Diseases0 citationsOpen Access

Smoking-attributable ischemic heart disease burden in China from 1990 to 2021 and projections to 2036: A retrospective analysis and forecasting study

Q: What are the key findings of this study?

Former smoking was associated with an 84% higher likelihood of heart disease compared to never smoking (AOR 1.84), contributing to a mortality burden in China that exceeds global averages.

Q: What question did this study set out to answer?

This research aims to assess the burden of smoking-attributable ischemic heart disease in China and project future trends by gender.

DXDingwen Xu ZYZhe Yang WYWeijuan Yao

Key Result

Former smoking was associated with an 84% higher likelihood of heart disease compared to never smoking (AOR 1.84), contributing to a mortality burden in China that exceeds global averages.

Key Points

This research aims to assess the burden of smoking-attributable ischemic heart disease in China and project future trends by gender.
Conducted a retrospective analysis of smoking-related ischemic heart disease data from 1990 to 2021
Analyzed gender-specific trends and disparities in disease burden
Projected future trends to 2036 based on historical data
Smoking-related ischemic heart disease burden in China exceeds global averages
Males show a worsening burden while females demonstrate improvement
Highlighted significant gender disparities in the health impacts of smoking

Study Design

Type

Observational (n=16,578)

Structured PICO

Does smoking increase the burden of ischemic heart disease and mortality in the Chinese population?

Population

Chinese adults aged ≥45 years (CHARLS cohort) and the general Chinese population (GBD data)

Intervention

Smoking (current or former)

Comparator

Never smokers

Outcome

Heart disease diagnosis (CHARLS) and smoking-related IHD mortality (ASMR), DALYs (ASDR), YLDs, and YLLs (GBD)hard clinical

Smoking contributes to a massive and growing burden of ischemic heart disease in China, particularly among males, highlighting an urgent need for targeted tobacco control interventions.

Main Result

Effect estimate: AOR 1.84 (95% CI 1.50-2.25)

Absolute Event Rate: 18.1% vs 12.7%

p-value: p=<0.001

Limitations

Estimation nature of GBD data may affect accuracy
Impact of new tobacco products has not been analyzed
Cross-sectional design of CHARLS cannot establish causal relationships
Lack of IHD specificity in the CHARLS outcome variable
ARIMA forecasting relies on the stability of historical data and does not capture uncertainties from dynamic changes in smoking behaviors or policies
Population-level nature of the data may introduce ecologic associations
Residual confounding may persist due to unmeasured factors such as socioeconomic status or dietary habits
Generalizability of the findings may be limited to the Chinese context

Abstract

The burden of smoking-related IHD in China exceeds the global average and reveals significant gender disparities, with a worsening burden for males and improvement for females. There is a critical need for more effective smoking control measures aimed at the male population to tackle this major public health issue.

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