Vicedo-Cabrera Ana M, Röösli Martin, Radovanovic Dragana, Grize Leticia, Witassek Fabienne, Schindler Christian, Perez Laura
Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Switzerland.
AMIS Plus Registry, Epidemiology, Biostatistics and Prevention Institute (EBPI). University of Zurich, Switzerland.
Swiss Med Wkly. 2016 Dec 19;146:w14381. doi: 10.4414/smw.2016.14381. eCollection 2016.
Smoking bans are considered one of the most effective policies to reduce population exposure to tobacco smoke and prevent adverse health outcomes. However, evidence on the effect of contextual variables on the effectiveness of smoking bans is still lacking.
The patchwork of cantonal smoke-free laws in Switzerland was used as a quasi-experimental setting to assess changes after their introduction in: hospitalisations and mortality due to cardiorespiratory diseases in adults; total hospitalisations and hospitalisations due to respiratory disorders in children; and the modifying effects of contextual factors and the effectiveness of the laws.
Using hospital and mortality registry data for residents in Switzerland (2005-2012), we conducted canton-specific interrupted time-series analyses followed by random effects meta-analyses to obtain nationwide smoking ban estimates by subgroups of age, sex and causes of hospitalisation or death. Heterogeneity of the impact caused by strictness of the ban and other smoking-related characteristics of the cantons was explored through meta-regression.
Total hospitalisation rates due to cardiovascular and respiratory diseases did not significantly change after the introduction of the ban. Post-ban changes were detected in ischaemic heart disease hospitalisations, with a 2.5% reduction (95% confidence interval [CI)] -6.2 to 1.3%) for all ages and 5.5% (95% CI -10.8 to -0.2%) in adults 35-64 years old. Total mortality due to respiratory diseases decreased by 8.2% (95% CI -15.2 to -0.6%) over all ages, and chronic obstructive pulmonary disease mortality decreased by 14.0% (95% CI -22.3 to -4.5%) in adults ≥65 years old. Cardiovascular mortality did not change after the introduction of the ban, but there was an indication of post-ban reductions in mortality due to hypertensive disorders (-5.4%, 95% CI -12.6 to 2.3%), and congestive heart failure (-6.0%, 95% CI -14.5 to 3.4%). No benefits were observed for hospitalisations due to respiratory diseases in children or for infant mortality. The type of smoking ban implemented explained the heterogeneity of benefits across cantons for some outcomes.
Smoking bans in Switzerland were associated with overall reductions in cardiovascular and respiratory hospitalisation and mortality in adults.
吸烟禁令被认为是减少人群接触烟草烟雾并预防不良健康后果的最有效政策之一。然而，关于背景变量对吸烟禁令有效性影响的证据仍然不足。
瑞士各州的无烟法律拼凑情况被用作准实验环境，以评估其实施后在以下方面的变化：成人因心肺疾病导致的住院率和死亡率；儿童的总住院率以及因呼吸系统疾病导致的住院率；背景因素的调节作用以及法律的有效性。
利用瑞士居民的医院和死亡率登记数据（2005 - 2012年），我们进行了各州特定的中断时间序列分析，随后进行随机效应荟萃分析，以按年龄、性别以及住院或死亡原因亚组获取全国范围内吸烟禁令的估计值。通过荟萃回归探讨了禁令严格程度以及各州其他与吸烟相关特征所造成影响的异质性。
禁令实施后，心血管和呼吸系统疾病导致的总住院率没有显著变化。在缺血性心脏病住院方面检测到禁令实施后的变化，所有年龄段的住院率下降了2.5%（95%置信区间[CI] -6.2至1.3%），35 - 64岁成年人的住院率下降了5.5%（95% CI -10.8至 -0.2%）。所有年龄段因呼吸系统疾病导致的总死亡率下降了8.2%（95% CI -15.2至 -0.6%），≥65岁成年人中慢性阻塞性肺疾病死亡率下降了14.0%（95% CI -22.3至 -4.5%）。禁令实施后心血管死亡率没有变化，但有迹象表明禁令实施后因高血压疾病导致的死亡率有所下降（-5.4%，95% CI -12.6至2.3%），以及因充血性心力衰竭导致的死亡率有所下降（-6.0%，95% CI -14.5至3.4%）。未观察到儿童因呼吸系统疾病住院或婴儿死亡率方面有受益情况。实施的吸烟禁令类型解释了部分结果中各州受益情况的异质性。
瑞士的吸烟禁令与成年人心血管和呼吸系统住院率及死亡率的总体下降相关。
