China, the leading global tobacco producer and consumer with 300 million smokers (50.5% male prevalence) and over one million smoking-attributable deaths annually, lacks a comprehensive socioeconomic burden assessment. This study aims to model the health and economic outcomes of three tobacco control policy scenarios to address this gap.
We employed data from GBD 2021 and Bayesian Age-Period-Cohort modelling to project smoking-attributable incidence, mortality, disability-adjusted life-years (DALYs) and indirect economic losses (2022–2040) for three scenarios: Reference (current trends), Complete Elimination (0% smoking by 2040), and Healthy China Targets (20% by 2030). Population attributable fractions covered five diseases. The indirect economic burden was estimated via human capital approach with per capita Gross Domestic Product (GDP) and productivity weights. Uncertainty intervals (UIs) and sensitivity analyses were performed to verify robustness.
Under reference scenario, cumulative smoking-attributable incident case occurrence (2022–2040) reached 18 934.60 million (95% UI: 14 163.25–23 705.94), resulting in 55.40 (35.76–75.04) million deaths and 960.31 (657.58–1263.05) million DALYs. Complete elimination would prevent 8972.94 (5744.43–12 201.46) million incident case occurrence, 24.97 (12.43–37.51) million deaths and 454.23 (260.26–648.20) million DALYs, and 22.27 trillion CNY (10.38–34.15) in indirect economic losses. Healthy China Targets would have averted 3.53 billion (2.26–4.80) incident case occurrence, 9.82 million (4.86–14.78) deaths, 178.91 (102.32–255.50) million DALYs and 8.78 (4.11–13.45) trillion CNY, respectively. Sensitivity analyses confirmed robustness, with overall deviations ranging from –3.4% to 0.0% across model variants.
Maintaining current policies is necessary to prevent further escalation of the smoking-attributable burden, but accelerated efforts towards smoking elimination in China would yield substantial health and economic benefits.