Kalkhoran Sara, Sebrié Ernesto M, Sandoya Edgardo, Glantz Stanton A
Department of Medicine, Cardiovascular Research Institute, University of California San Francisco, San Francisco, California.
Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York.
Am J Prev Med. 2015 Jul;49(1):85-8. doi: 10.1016/j.amepre.2014.12.009. Epub 2015 May 18.
Implementation of smokefree laws is followed by drops in hospital admissions for cardiovascular diseases and asthma. The impact of smokefree laws on use of non-hospital medical services has not been assessed. The purpose of this study is to evaluate the impact of Uruguay's national 100% smokefree legislation on non-hospital emergency care visits, hospitalizations for bronchospasm, and bronchodilator use.
The monthly number of non-hospital emergency care visits and hospitalizations for bronchospasm, as well as monthly puffs of bronchodilators (total and per person), from 3 years prior to the adoption of the 100% smokefree policy on March 1, 2006, through 5 years after the policy were assessed using interrupted time series negative binomial regression. Data analysis was conducted in 2014.
The incidence of non-hospital emergency visits for bronchospasm decreased by 15% (incidence rate ratio [IRR]=0.85, 95% CI=0.76, 0.94) following implementation of the law. Hospitalizations for bronchospasm did not change significantly (IRR=0.89, 95% CI=0.66, 1.21). Total monthly puffs of salbutamol and ipratropium administered in the non-hospital emergency setting decreased by 224 (95% CI=-372, -76) and 179 (95% CI=-340, -18.6), respectively, from means of 1,222 and 1,007 before the law.
Uruguay's 100% smokefree law was followed by fewer emergency visits for bronchospasm and less need for treatment, supporting adoption of such policies in low- and middle-income countries to reduce the disease burden and healthcare costs associated with smoking.
无烟法律实施后，心血管疾病和哮喘的住院人数有所下降。无烟法律对非医院医疗服务使用的影响尚未得到评估。本研究的目的是评估乌拉圭全国100%无烟立法对非医院急诊就诊、支气管痉挛住院治疗以及支气管扩张剂使用的影响。
采用中断时间序列负二项回归分析，评估从2006年3月1日实施100%无烟政策前3年至政策实施后5年期间，每月非医院急诊就诊和支气管痉挛住院的次数，以及每月支气管扩张剂的使用量（总量和人均量）。数据分析于2014年进行。
法律实施后，支气管痉挛的非医院急诊就诊发生率下降了15%（发生率比[IRR]=0.85，95%置信区间[CI]=0.76，0.94）。支气管痉挛的住院人数没有显著变化（IRR=0.89，95%CI=0.66，1.21）。在非医院急诊环境中，沙丁胺醇和异丙托溴铵的每月使用总量分别比法律实施前的均值1222和1007减少了224（95%CI=-372，-76）和179（95%CI=-340，-18.6）。
乌拉圭的100%无烟法律实施后，支气管痉挛的急诊就诊次数减少，治疗需求降低，这支持在低收入和中等收入国家采用此类政策，以减轻与吸烟相关的疾病负担和医疗费用。
