The impact of Shanghai's comprehensive smoke-free legislation on hospitalization and mortality rates of ischemic heart disease: An interrupted time series analysis.

IF 1.9 4区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Tobacco Induced Diseases Pub Date : 2025-09-24 eCollection Date: 2025-01-01 DOI:10.18332/tid/207350

Lihang Sun, Huiting Yu, De Chen, Dan Qin, Ying Shi, Yafei Hu, Jingrong Gao, Chenchen Xie, Xin Chen, Haiyin Wang

{"title":"The impact of Shanghai's comprehensive smoke-free legislation on hospitalization and mortality rates of ischemic heart disease: An interrupted time series analysis.","authors":"Lihang Sun, Huiting Yu, De Chen, Dan Qin, Ying Shi, Yafei Hu, Jingrong Gao, Chenchen Xie, Xin Chen, Haiyin Wang","doi":"10.18332/tid/207350","DOIUrl":null,"url":null,"abstract":"Introduction: Smoking and secondhand smoke are major global health threats, significantly contributing to the burden of ischemic heart disease (IHD). Despite the implementation of tobacco control policies worldwide, limited evidence exists on the health impacts in Shanghai. This study evaluates the effects of Shanghai's 2017 smoke-free legislation on IHD hospitalization and mortality rates.Methods: We conducted Interrupted Time Series (ITS) method to analyze monthly data on IHD hospitalizations and mortality among registered residents of Shanghai from July 2013 to December 2021. Age-standardized rate, Poisson and negative binomial regression models were performed to control for covariates.Results: We included 898535 hospitalizations and 180658 deaths caused by IHD from July 2013 to December 2021 in Shanghai. Following policy implementation, there was a significant immediate increase (β=8.29; 95% CI: 2.45-14.13) and post-trend decline (β= -0.73; 95% CI: -0.93 - -0.54) in IHD hospitalization, which is estimated to have prevented approximately 890 hospitalizations per year. Subgroup analysis revealed that the long-term decrease was more pronounced in individuals aged ≥65 years (β= -1.72; 95% CI: -2.21 - -1.24), compared to those aged 35-64 years (β= -0.33; 95% CI: -0.42 - -0.25). However, mortality rates showed no statistically significant immediate (β= -0.90, 95% CI: -4.76-2.95) or long-term changes (β= -0.0075; 95% CI: -0.14-0.12).Conclusions: Shanghai's comprehensive smoke-free legislation appears to be associated with a significant long-term reduction in hospitalization rates and a modest decrease in mortality rates from ischemic heart disease, particularly among older adults. These findings support the potential cardiovascular health benefits of smoke-free policies, which provide useful evidence for other cities considering the adoption or reinforcement of comprehensive public smoking bans to help reduce the burden of cardiovascular disease and improve population health.","PeriodicalId":23202,"journal":{"name":"Tobacco Induced Diseases","volume":"23 ","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12459251/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Tobacco Induced Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.18332/tid/207350","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction: Smoking and secondhand smoke are major global health threats, significantly contributing to the burden of ischemic heart disease (IHD). Despite the implementation of tobacco control policies worldwide, limited evidence exists on the health impacts in Shanghai. This study evaluates the effects of Shanghai's 2017 smoke-free legislation on IHD hospitalization and mortality rates.

Methods: We conducted Interrupted Time Series (ITS) method to analyze monthly data on IHD hospitalizations and mortality among registered residents of Shanghai from July 2013 to December 2021. Age-standardized rate, Poisson and negative binomial regression models were performed to control for covariates.

Results: We included 898535 hospitalizations and 180658 deaths caused by IHD from July 2013 to December 2021 in Shanghai. Following policy implementation, there was a significant immediate increase (β=8.29; 95% CI: 2.45-14.13) and post-trend decline (β= -0.73; 95% CI: -0.93 - -0.54) in IHD hospitalization, which is estimated to have prevented approximately 890 hospitalizations per year. Subgroup analysis revealed that the long-term decrease was more pronounced in individuals aged ≥65 years (β= -1.72; 95% CI: -2.21 - -1.24), compared to those aged 35-64 years (β= -0.33; 95% CI: -0.42 - -0.25). However, mortality rates showed no statistically significant immediate (β= -0.90, 95% CI: -4.76-2.95) or long-term changes (β= -0.0075; 95% CI: -0.14-0.12).

Conclusions: Shanghai's comprehensive smoke-free legislation appears to be associated with a significant long-term reduction in hospitalization rates and a modest decrease in mortality rates from ischemic heart disease, particularly among older adults. These findings support the potential cardiovascular health benefits of smoke-free policies, which provide useful evidence for other cities considering the adoption or reinforcement of comprehensive public smoking bans to help reduce the burden of cardiovascular disease and improve population health.

查看原文本刊更多论文

上海市全面禁烟立法对缺血性心脏病住院率和死亡率的影响：中断时间序列分析

吸烟和二手烟是全球主要的健康威胁，是造成缺血性心脏病（IHD）负担的重要因素。尽管世界各国都实施了控烟政策，但上海地区控烟对健康的影响证据有限。本研究评估了上海市2017年无烟立法对IHD住院率和死亡率的影响。方法：采用中断时间序列（ITS）方法分析2013年7月至2021年12月上海市户籍居民IHD住院和死亡率的月度数据。采用年龄标准化率、泊松和负二项回归模型控制协变量。结果：我们纳入了2013年7月至2021年12月上海因IHD住院898535例，死亡180658例。政策实施后，IHD住院人数立即显著增加（β=8.29; 95% CI: 2.45-14.13），趋势后下降（β= -0.73; 95% CI: -0.93 - -0.54），估计每年可避免约890人住院。亚组分析显示，与35-64岁人群（β= -0.33; 95% CI: -0.42 - -0.25）相比，≥65岁人群的长期下降更为明显（β= -1.72; 95% CI: -2.21 - -1.24）。然而，死亡率在近期（β= -0.90, 95% CI: -4.76-2.95）或长期变化（β= -0.0075, 95% CI: -0.14-0.12）均无统计学意义。结论：上海的全面无烟立法似乎与住院率的长期显著降低和缺血性心脏病死亡率的适度降低有关，特别是在老年人中。这些发现支持了无烟政策对心血管健康的潜在益处，为其他考虑采用或加强公共场所全面禁烟以帮助减轻心血管疾病负担和改善人口健康的城市提供了有用的证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Tobacco Induced Diseases SUBSTANCE ABUSE-PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

CiteScore

5.30

自引率

5.40%

发文量

审稿时长

12 weeks

期刊介绍： Tobacco Induced Diseases encompasses all aspects of research related to the prevention and control of tobacco use at a global level. Preventing diseases attributable to tobacco is only one aspect of the journal, whose overall scope is to provide a forum for the publication of research articles that can contribute to reducing the burden of tobacco induced diseases globally. To address this epidemic we believe that there must be an avenue for the publication of research/policy activities on tobacco control initiatives that may be very important at a regional and national level. This approach provides a very important "hands on" service to the tobacco control community at a global scale - as common problems have common solutions. Hence, we see ourselves as "connectors" within this global community. The journal hence encourages the submission of articles from all medical, biological and psychosocial disciplines, ranging from medical and dental clinicians, through health professionals to basic biomedical and clinical scientists.