Division of Neonatology, Department of Paediatrics, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands; Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands; Institute for Analytical Sociology, Department of Management and Engineering, Linköping University, Norrköping, Sweden.
Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands.
Lancet Public Health. 2022 Jul;7(7):e616-e625. doi: 10.1016/S2468-2667(22)00112-8.
There are few quantitative studies into the effect of comprehensive smoke-free legislation on neonatal and infant mortality in middle-income countries. We aimed to estimate the effects of implementing comprehensive smoke-free legislation on neonatal mortality and infant mortality across all middle-income countries.
We applied the synthetic control method using 1990-2018 country-level panel data for 106 middle-income countries from the WHO, World Bank, and Penn World datasets. Outcome variables were neonatal (age 0-28 days) mortality and infant (age 0-12 months) mortality rates per 1000 livebirths per year. For each middle-income country with comprehensive smoke-free legislation, a synthetic control country was constructed from middle-income countries without comprehensive smoke-free legislation, but with similar prelegislation trends in the outcome and predictor variables. Overall legislation effect was the mean average of country-specific effects weighted by the number of livebirths. We compared the distribution of the legislation effects with that of the placebo effects to assess the likelihood that the observed effect was related to the implementation of smoke-free legislation and not merely influenced by other processes.
31 (29%) of 106 middle-income countries introduced comprehensive smoke-free legislation and had outcome data for at least 3 years after the intervention. We were able to construct a synthetic control country for 18 countries for neonatal mortality and for 15 countries for infant mortality. Comprehensive smoke-free legislation was followed by a mean yearly decrease of 1·63% in neonatal mortality and a mean yearly decrease of 1·33% in infant mortality. An estimated 12 392 neonatal deaths in 18 countries and 8932 infant deaths in 15 countries were avoided over 3 years following the implementation of comprehensive smoke-free legislation. We estimated that an additional 104 063 infant deaths (including 95 850 neonatal deaths) could have been avoided over 3 years if the 72 control middle-income countries had introduced this legislation in 2015. 220 (43%) of 514 placebo effects for neonatal mortality and 112 (39%) of 289 for infant mortality were larger than the estimated aggregated legislation effect, indicating a degree of uncertainty around our estimates. Sensitivity analyses showed results that were consistent with the main analysis and suggested a dose-response association related to comprehensiveness of the legislation.
Implementing comprehensive smoke-free legislation in middle-income countries could substantially reduce preventable deaths in neonates and infants.
Dutch Heart Foundation, Lung Foundation Netherlands, Dutch Cancer Society, Dutch Diabetes Research Foundation, Netherlands Thrombosis Foundation, Health Data Research UK.
关于综合性无烟立法对中等收入国家新生儿和婴儿死亡率的影响，定量研究较少。我们旨在估计在所有中等收入国家实施综合性无烟立法对新生儿死亡率和婴儿死亡率的影响。
我们使用来自世卫组织、世界银行和宾州世界数据集的 1990 年至 2018 年各国的面板数据，采用综合控制法。结果变量为新生儿（0-28 天）死亡率和婴儿（0-12 个月）死亡率，每年每 1000 例活产 1000 例。对于有综合性无烟立法的每个中等收入国家，从没有综合性无烟立法但结果和预测变量有类似立法前趋势的中等收入国家中，构建了一个合成对照国家。总体立法效果是按活产数加权的特定国家效果的平均值。我们将立法效果的分布与安慰剂效果的分布进行比较，以评估观察到的效果与实施无烟立法相关的可能性，而不仅仅受其他过程的影响。
106 个中等收入国家中有 31 个（29%）实施了综合性无烟立法，并且干预后至少有 3 年的结果数据。我们能够为 18 个国家的新生儿死亡率和 15 个国家的婴儿死亡率构建一个合成对照国家。实施综合性无烟立法后，新生儿死亡率每年平均下降 1.63%，婴儿死亡率每年平均下降 1.33%。在实施综合性无烟立法后 3 年内，18 个国家估计避免了 12392 例新生儿死亡，15 个国家避免了 8932 例婴儿死亡。如果 2015 年 72 个对照中等收入国家实施了这项立法，估计在 3 年内还可以避免另外 104063 例婴儿死亡（包括 95850 例新生儿死亡）。220 项（43%）新生儿死亡率和 112 项（39%）婴儿死亡率的安慰剂效应大于估计的综合立法效应，表明我们的估计存在一定程度的不确定性。敏感性分析结果与主要分析一致，并表明与立法全面性相关的剂量反应关系。
在中等收入国家实施综合性无烟立法可以显著减少新生儿和婴儿的可预防死亡。
荷兰心脏基金会、荷兰肺脏基金会、荷兰癌症协会、荷兰糖尿病研究基金会、荷兰血栓形成基金会、英国健康数据研究。
