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Abstract
Background Cigarette smoking imposes substantial health and economic burdens on China, yet its full impact remains significantly underestimated and based on outdated data. This study aims to comprehensively assess the direct and indirect economic costs of cigarette smoking from 2014 to 2020.
Methods From a societal perspective, the study uses the subtractive method in conjunction with propensity score matching to estimate direct costs, particularly excess healthcare expenditures incurred by people who smoke compared with those who have never smoked. Additionally, indirect costs, including productivity losses due to premature mortality and morbidity, are quantified using disability-adjusted life-years and the human capital approach.
Results The total economic cost of cigarette smoking in China increased significantly from 1.40 trillion RMB in 2014 to 2.43 trillion RMB in 2020, representing an average of 2.29% of Gross Domestic Product (GDP) annually. In contrast, the fiscal benefits derived from the tobacco industry, including tax revenue and profits, were substantially lower, amounting to 1.52 trillion RMB in 2020. This disparity reveals that the economic cost of cigarette smoking was approximately 1.6 times greater than the fiscal gains, undermining the narrative that the tobacco industry is economically advantageous.
Conclusions This study underscores the unsustainability of relying on revenues from the tobacco industry and emphasises the urgent need for comprehensive tobacco control policies in China. Policy-makers should prioritise raising tobacco taxes and adopting effective strategies to reduce smoking prevalence, thereby safeguarding long-term public health and promoting economic sustainability.
- Economics
- Public policy
- Tobacco industry
- Taxation
Data availability statement
Data are available on reasonable request. 1.The CFPS data consist of deidentified participant data collected through biennial household surveys. The data are publicly available from the Institute of Social Science Survey (ISSS) at Peking University. Researchers can request access via the CFPS official website (http://www.isss.pku.edu.cn/cfps) on completing a formal application process. Reuse of the data is permitted under the terms outlined by the ISSS, which include academic and non-commercial purposes only. For further inquiries, contact the CFPS team at cfps@pku.edu.cn. 2. The GBD data include publicly available, aggregated estimates of disease burden, including disability-adjusted life-years (DALYs) attributed to various risk factors such as smoking. These data are accessible through the Institute for Health Metrics and Evaluation (IHME) website (http://ghdx.healthdata.org/gbd-results-tool). The reuse of GBD data is permitted under IHME's open access policy for academic and non-commercial purposes. Additional information and protocols are available at the IHME website. For queries, contact IHME at ihme@uw.edu.
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Data availability statement
Data are available on reasonable request. 1.The CFPS data consist of deidentified participant data collected through biennial household surveys. The data are publicly available from the Institute of Social Science Survey (ISSS) at Peking University. Researchers can request access via the CFPS official website (http://www.isss.pku.edu.cn/cfps) on completing a formal application process. Reuse of the data is permitted under the terms outlined by the ISSS, which include academic and non-commercial purposes only. For further inquiries, contact the CFPS team at cfps@pku.edu.cn. 2. The GBD data include publicly available, aggregated estimates of disease burden, including disability-adjusted life-years (DALYs) attributed to various risk factors such as smoking. These data are accessible through the Institute for Health Metrics and Evaluation (IHME) website (http://ghdx.healthdata.org/gbd-results-tool). The reuse of GBD data is permitted under IHME's open access policy for academic and non-commercial purposes. Additional information and protocols are available at the IHME website. For queries, contact IHME at ihme@uw.edu.
Footnotes
Contributors Concept and design: RZ and XH. Acquisition, analysis or interpretation of data: all authors. Drafting of the manuscript: LM. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: LM and AH. Obtaining funding: RZ and XH. Administrative, technical or material support: RZ and XH. Supervision: XH. RZ is the guarantor. All authors approved the final version.
Funding This project is funded by the Tobacco-Free Kids Action Fund (CHINA-28-05 & CHINA-33-04).
Competing interests No, there are no competing interests.
Provenance and peer review Not commissioned; externally peer reviewed.
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