Lihang Sun, Huiting Yu, De Chen, Dan Qin, Ying Shi, Yafei Hu, Jingrong Gao, Chenchen Xie, Xin Chen, Haiyin Wang
{"title":"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","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":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","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":"{\"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\":\"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>\",\"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}","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}
The impact of Shanghai's comprehensive smoke-free legislation on hospitalization and mortality rates of ischemic heart disease: An interrupted time series analysis.
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.
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.
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