Department of Epidemiology, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China.
Department of Respiratory and Critical Care Medicine, Xi'an No.3 Hospital, The Affiliated Hospital of Northwest University, Xi'an, China.
Front Public Health. 2022 Jun 21;10:898461. doi: 10.3389/fpubh.2022.898461. eCollection 2022.
Smoking and secondhand smoke (SHS) exposure rates are much higher in China than in other countries. A smoke-free policy was implemented in Xi'an, a city in Shaanxi Province, China, on November 1, 2018. This study aimed to evaluate the effect of the smoke-free policy on changes in hospital admissions for acute ischemic heart disease (AIHD) and stroke in Xi'an.
All subjects had been hospitalized for AIHD or stroke from February 9, 2017 to December 25, 2019 (study period: 150 weeks) in six randomly selected public hospitals out of 36 tertiary hospitals in Xi'an. A generalized additive model developed using an interrupted time series design was used to compare immediate and annual percent changes in hospital admissions before and after policy implementation.
The study included 31,400 cases (16,656 cases of AIHD and 14,744 cases of stroke) from 6 hospitals in Xi'an. Immediately after implementation of the smoke-free policy, AIHD admissions were reduced significantly (-31.66%, 95% CI: - 39.45 to -22.86%), but stroke admissions were not (-4.94%, 95% CI: -13.26 to 4.17%). The annual reduction in stroke-related admissions (-14.54%, 95% CI: -23.53 to -4.49%) and the annual increase in AIHD-related admissions (40.58%, 95% CI: 22.08 to 61.87%) were significant. Although there was no significant reduction in AIHD admissions, stroke admissions were significantly reduced by -15.73% (from 7,350 to 6,194) after implementation of the smoke-free policy in Xi'an.
The smoke-free policy had different effects on hospital admissions for AIHD and stroke in Xi'an. Xi'an should improve its smoke-free legislation and expand the measures to maintain or achieve additional significant health benefits. These findings can guide the formulation and implementation of regional and national smoke-free policies.
中国的吸烟率和二手烟暴露率远高于其他国家。2018 年 11 月 1 日，中国陕西省西安市实施了无烟政策。本研究旨在评估西安市无烟政策对急性缺血性心脏病（AIHD）和中风住院人数变化的影响。
所有患者均于 2017 年 2 月 9 日至 2019 年 12 月 25 日（研究期间：150 周）在西安市 36 家三级医院中随机选择的 6 家公立医院住院治疗 AIHD 或中风。采用广义相加模型，采用中断时间序列设计，比较政策实施前后住院人数的即时和年度百分比变化。
本研究纳入了西安市 6 家医院的 31400 例病例（16656 例 AIHD 和 14744 例中风）。无烟政策实施后，AIHD 住院人数立即显著减少（-31.66%，95%CI：-39.45 至-22.86%），但中风住院人数并未减少（-4.94%，95%CI：-13.26 至 4.17%）。中风相关住院人数的年降幅（-14.54%，95%CI：-23.53 至-4.49%）和 AIHD 相关住院人数的年增幅（40.58%，95%CI：22.08 至 61.87%）均有显著意义。尽管 AIHD 住院人数没有显著减少，但实施无烟政策后，中风住院人数显著减少了 15.73%（从 7350 例降至 6194 例）。
无烟政策对西安市 AIHD 和中风住院人数的影响不同。西安市应完善其无烟立法并扩大措施范围，以维持或获得额外的显著健康效益。这些发现可以为区域和国家无烟政策的制定和实施提供指导。
