无烟立法对英格兰出生结局的保护作用：一项断点回归设计
Protective Effects of Smoke-free Legislation on Birth Outcomes in England: A Regression Discontinuity Design.
作者信息
Bakolis Ioannis, Kelly Ruth, Fecht Daniela, Best Nicky, Millett Christopher, Garwood Kevin, Elliott Paul, Hansell Anna L, Hodgson Susan
机构信息
From the aUK Small Area Health Statistics Unit & MRC-PHE Centre for Environment and Health, School of Public Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom; bHealth Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom, cDepartment of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; dDepartment of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom; eThe Medical Research Council, London, United Kingdom; fDepartment of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom; gDirectorate of Public Health and Primary Care, Imperial College Healthcare NHS Trust, London, United Kingdom; and hMRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
出版信息
Epidemiology. 2016 Nov;27(6):810-8. doi: 10.1097/EDE.0000000000000534.
BACKGROUND
Environmental tobacco smoke has an adverse association with preterm birth and birth weight. England introduced a new law to make virtually all enclosed public places and workplaces smoke free on July 1, 2007. We investigated the effect of smoke-free legislation on birth outcomes in England using Hospital Episode Statistics (HES) maternity data.
METHODS
We used regression discontinuity, a quasi-experimental study design, which can facilitate valid causal inference, to analyze short-term effects of smoke-free legislation on birth weight, low birth weight, gestational age, preterm birth, and small for gestational age.
RESULTS
We analyzed 1,800,906 pregnancies resulting in singleton live-births in England between 1 January 2005 and 31 December 2009. In the 1 to 5 months following the introduction of the smoke-free legislation, for those entering their third trimester, the risk of low birth weight decreased by between 8% (95% confidence interval [CI]: 4%, 12%) and 14% (95% CI: 5%, 23%), very low birth weight between 28% (95% CI: 19%, 36%) and 32% (95% CI: 21%, 41%), preterm birth between 4% (95% CI: 1%, 8%) and 9% (95% CI: 2%, 16%), and small for gestational age between 5% (95% CI: 2%, 8%) and 9% (95% CI: 2%, 15%). The estimated impact of the smoke-free legislation varied by maternal age, deprivation, ethnicity, and region.
CONCLUSIONS
The introduction of smoke-free legislation in England had an immediate estimated beneficial impact on birth outcomes overall, although we did not observe improvements across all age, ethnic, or deprivation groups.See video abstract at http://links.lww.com/EDE/B85.
背景
环境烟草烟雾与早产和出生体重存在不良关联。英国于2007年7月1日实施了一项新法律，使几乎所有封闭的公共场所和工作场所都成为无烟场所。我们利用医院事件统计（HES）产妇数据调查了无烟立法对英国出生结局的影响。
方法
我们采用回归断点设计，这是一种准实验研究设计，有助于进行有效的因果推断，以分析无烟立法对出生体重、低出生体重、孕周、早产和小于胎龄儿的短期影响。
结果
我们分析了2005年1月1日至2009年12月31日期间英格兰1,800,906例单胎活产妊娠。在无烟立法实施后的1至5个月内，对于进入孕晚期的孕妇，低出生体重风险降低了8%（95%置信区间[CI]：4%，12%）至14%（95%CI：5%，23%），极低出生体重降低了28%（95%CI：19%，36%）至32%（95%CI：21%，41%），早产降低了4%（95%CI：1%，8%）至9%（95%CI：2%，16%），小于胎龄儿降低了5%（95%CI：2%，8%）至9%（95%CI：2%，15%）。无烟立法的估计影响因产妇年龄、贫困程度、种族和地区而异。
结论
英国无烟立法的实施总体上对出生结局有直接的估计有益影响，尽管我们并未观察到所有年龄、种族或贫困群体都有所改善。见视频摘要：http://links.lww.com/EDE/B85 。
Zotero 插件