Smoking, Gender and Disease

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As epidemiologists struggle to understand the biology of the novel Coronavirus, one question has been the role of smoking. There is evidence that the virus hits habitual smokers particularly hard and may play a role in the relative lethality of infection. It sort of stands to reason that this could be the case and there are few studies examining the question and attempting to quantify the potential impact. That is all tentative and I’m certainly not an expert. So I don’t want to dwell on that question. But reading up on this did allow me to learn some statistics about smoking in China that I found genuinely stunning.

First, 52.1% of Chinese men smoke. That is quite high. Smoking in the US peaked in the 1950s at around 45%. It’s now just under 15%. (Since smoking at the time was heavily gendered, the total for men was likely significantly higher.) Some countries are even higher. 59% of Russian men smoke. Indonesia is 76% for men. (The highest smoking rates in the world tend to be in the Balkans and Eastern Europe. Russia has by far the largest percentage of smokers among the world’s biggest countries by population.)

But this wasn’t the number I found most surprising. It was how deeply gendered smoking is in China. 52% of men smoke but only between 1% and 3% of Chinese women do. In other words, smoking in China is an almost exclusively male phenomenon. The delta between the two numbers is what surprised me most.

Smoking in the US used to be highly gendered. But that is much less so today after decades in which tobacco companies marketed smoking as a form of female empowerment. Today about 14% or 15% of Americans smoke – 15.6% for men versus 12% for women, according to this recent CDC data.

Scanning other country rates, the only countries which seems to have comparably gendered smoking rates are a series of conservative Islamic and/or Middle Eastern countries. In Egypt and Iran, fewer than 1% of women smoke. In Saudi Arabia, it’s under 3%. Each have fairly high rates of smoking for men. Indonesia is a particular standout – 76% of men smoke and 3.6% of women.

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