Rayens Mary Kay, Burkhart Patricia V, Zhang Mei, Lee Seongjik, Moser Debra K, Mannino David, Hahn Ellen J
College of Nursing, University of Kentucky, Lexington, Kentucky, USA.
J Allergy Clin Immunol. 2008 Sep;122(3):537-41.e3. doi: 10.1016/j.jaci.2008.06.029. Epub 2008 Aug 9.
Secondhand tobacco smoke increases the risk for the development and increasing severity of asthma among adults and children. Reducing exposure to secondhand smoke decreases symptomatic exacerbations among patients with asthma. Emergency department (ED) visits for asthma were assessed before and after the implementation of smoke-free legislation in Lexington-Fayette County, Ky.
To evaluate the effects of a smoke-free law on the rate of ED visits for asthma.
The study included ED visits for asthma from 4 hospitals in Lexington-Fayette County, Ky. Age-adjusted rates of asthma ED visits were determined. Poisson regression analysis of ED visits from January 1, 2001, to December 31, 2006 compared the ED visit rates between prelaw and postlaw, adjusting for seasonality, secular trends over time, and differences among demographic subgroups. The actual rates were graphed with the Poisson curve showing the rates predicted by the model. A second prediction curve was generated to show the projected rates in the postlaw period if the law had not been implemented.
Adjusting for seasonality, secular trends, and demographic characteristics, ED visits for asthma declined 22% from prelaw to postlaw (P < .0001; 95% CI, 14% to 29%). The rate of decline was 24% in adults age 20 years and older (P < .0001), whereas the decrease among children 19 years or younger was 18% (P = .01).
Although this study did not establish causation, the smoke-free law was associated with fewer asthma ED visits among both children and adults, with a more significant decline among adults.
二手烟草烟雾会增加成人和儿童患哮喘以及哮喘病情加重的风险。减少二手烟暴露可降低哮喘患者的症状加重情况。对肯塔基州列克星敦-费耶特县实施无烟立法前后的哮喘急诊就诊情况进行了评估。
评估无烟法律对哮喘急诊就诊率的影响。
该研究纳入了肯塔基州列克星敦-费耶特县4家医院的哮喘急诊就诊病例。确定了年龄调整后的哮喘急诊就诊率。对2001年1月1日至2006年12月31日的急诊就诊情况进行泊松回归分析，比较了立法前和立法后的急诊就诊率，并对季节性、随时间的长期趋势以及人口亚组之间的差异进行了调整。实际发生率与显示模型预测发生率的泊松曲线一起绘制。生成了第二条预测曲线，以显示如果未实施该法律，立法后时期的预计发生率。
在对季节性、长期趋势和人口特征进行调整后，哮喘急诊就诊次数从立法前到立法后下降了22%（P < .0001；95% CI，14%至29%）。20岁及以上成年人的下降率为24%（P < .0001），而19岁及以下儿童的下降率为18%（P = .01）。
尽管本研究未确立因果关系，但无烟法律与儿童和成人哮喘急诊就诊次数减少相关，其中成年人的下降更为显著。
