中国北京市综合性控烟政策对心血管疾病的影响。

The impact of comprehensive tobacco control policies on cardiovascular diseases in Beijing, China.

机构信息

Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.

Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China.

出版信息

Addiction. 2021 Aug;116(8):2175-2184. doi: 10.1111/add.15406. Epub 2021 Jan 28.

DOI:10.1111/add.15406

PMID:33404152

Abstract

BACKGROUND AND AIMS

China has a high smoking prevalence, but lacks effective tobacco control interventions. In 2015, comprehensive policies that incorporated all six aspects of MPOWER were implemented in Beijing and were considered the strictest tobacco control policy implemented in China to date. Decreases in the prevalence of active smoking and secondhand smoke (SHS) exposure were observed thereafter. This study aimed to evaluate the impact of Beijing's 2015 tobacco control policy package on cardiovascular diseases (CVDs).

DESIGN

Interrupted time-series study.

SETTING

Beijing, China.

PARTICIPANTS

A total of 17.7 million employees enrolled in Urban Employee Basic Medical Insurance (UEBMI) between January 2013 to June 2017.

INTERVENTIONS

Beijing's 2015 comprehensive tobacco policy package, combining a complete ban on smoking in indoor public places, cessation support, more comprehensive bans on advertising, and tax rises.

MEASUREMENTS

The main outcome was hospital admissions for all CVDs and five major cause-specific CVDs, including ischaemic heart disease (IHD), heart failure (HF), heart rhythm disturbances (HRDs), stroke and other cerebrovascular diseases (CBDs). The absolute number and proportion of reductions in the number of hospital admissions after the policies are reported.

FINDINGS

A total of 419 875 hospital admissions for CVD were identified. In total, 13.4% [95% confidence interval (CI) = 11.5%, 15.3%] of hospital admissions for CVD were averted by the tobacco control policies. For major cause-specific CVDs, significant hospital admission reductions occurred for IHD (5.4%, 95% CI = 2.6%, 8.3%), stroke (21.2%, 95% CI = 17.8%, 24.6%) and other CBDs (25.9%, 95% CI = 20.8%, 31.0%), but not for HF (4.7%, 95% CI = -4.2%, 13.5%) or HRDs (4.7%, 95% CI = -2.9%, 12.3%).

CONCLUSIONS

Beijing's 2015 tobacco control policy package appears to have been associated with a more than 10% reduction in all cardiovascular hospital admissions, including a more than 20% reduction in admissions for cerebrovascular diseases.

摘要

背景与目的

中国吸烟率较高，但缺乏有效的控烟干预措施。2015 年，北京市实施了包含 MPOWER 全部六项措施的综合性政策，被认为是迄今为止中国实施的最严格的控烟政策。此后，观察到主动吸烟和二手烟（SHS）暴露的流行率下降。本研究旨在评估北京 2015 年控烟政策对心血管疾病（CVDs）的影响。

设计

中断时间序列研究。

地点

中国北京。

参与者

2013 年 1 月至 2017 年 6 月期间，共有 1770 万参加城镇职工基本医疗保险（UEBMI）的员工纳入研究。

干预措施

北京市 2015 年综合烟草政策包，包括室内公共场所全面禁烟、戒烟支持、更全面的广告禁令以及提高税收。

测量

主要结果是所有 CVDs 和五种主要的特定 CVDs 的住院人数，包括缺血性心脏病（IHD）、心力衰竭（HF）、心律紊乱（HRD）、中风和其他脑血管疾病（CBDs）。报告政策后住院人数减少的绝对数量和比例。

结果

共确定了 419875 例 CVD 住院病例。烟草控制政策共避免了 13.4%（95%置信区间 [CI] = 11.5%，15.3%）的 CVD 住院。对于主要的特定 CVDs，IHD（5.4%，95%CI = 2.6%，8.3%）、中风（21.2%，95%CI = 17.8%，24.6%）和其他 CBDs（25.9%，95%CI = 20.8%，31.0%）的住院人数显著减少，但 HF（4.7%，95%CI = -4.2%，13.5%）和 HRD（4.7%，95%CI = -2.9%，12.3%）则没有。