Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan.
Institute for Nature, Health, and Agricultural Research (INHAR), Yaoundé, Cameroon.
JAMA Netw Open. 2023 Jul 3;6(7):e2322341. doi: 10.1001/jamanetworkopen.2023.22341.
Smoking causes considerable noncommunicable diseases, perinatal morbidity, and mortality.
To investigate the associations of population-level tobacco-control policies with health outcomes.
PubMed, EMBASE, Web of Science, Cumulated Index to Nursing and Allied Health Literature, and EconLit were searched from inception to March 2021 (updated on 1 March 2022). References were manually searched.
Studies reporting on associations of population-level tobacco control policies with health-related outcomes were included. Data were analyzed from May to July 2022.
Data were extracted by 1 investigator and cross-checked by a second investigator. Analyses were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline.
The primary outcomes were respiratory system disease (RSD), cardiovascular disease (CVD), cancer, mortality, hospitalization, and health care utilization. The secondary outcomes were adverse birth outcomes, such as low birth weight and preterm birth. Random-effects meta-analysis was used to estimate pooled odds ratios (ORs) and 95% CIs.
Of 4952 records identified, 144 population-level studies were included in the final analysis; 126 studies (87.5%) were of high or moderate quality. The most frequently reported policies were smoke-free legislation (126 studies), followed by tax or price increases (14 studies), multicomponent tobacco control programs (12 studies), and a minimum cigarette purchase age law (1 study). Smoke-free legislation was associated with decreased risk of all CVD events (OR, 0.90; 95% CI, 0.86-0.94), RSD events (OR, 0.83; 95% CI, 0.72-0.96), hospitalization due to CVD or RSD (OR, 0.91; 95% CI, 0.87-0.95), and adverse birth outcomes (OR, 0.94; 95% CI, 0.92-0.96). These associations persisted in all sensitivity and subgroup analyses, except for the country income category, for which a significant reduction was only observed in high-income countries. In meta-analysis, there was no clear association of tax or price increases with adverse health outcomes. However, for the narrative synthesis, all 8 studies reported statistically significant associations between tax increases and decreases in adverse health events.
In this systematic review and meta-analysis, smoke-free legislation was associated with significant reductions in morbidity and mortality related to CVD, RSD, and perinatal outcomes. These findings support the need to accelerate the implementation of smoke-free laws to protect populations against smoking-related harm.
吸烟会导致相当多的非传染性疾病、围产期发病率和死亡率。
研究人口层面的烟草控制政策与健康结果之间的关联。
从成立到 2021 年 3 月（2022 年 3 月 1 日更新），在 PubMed、EMBASE、Web of Science、Cumulated Index to Nursing and Allied Health Literature 和 EconLit 上进行了搜索。还手动搜索了参考文献。
纳入了报告人口层面烟草控制政策与健康相关结果之间关联的研究。数据于 2022 年 5 月至 7 月进行分析。
由一名调查员进行数据提取，并由第二名调查员进行交叉核对。使用系统评价和荟萃分析的首选报告项目进行分析报告准则。
主要结果是呼吸系统疾病 (RSD)、心血管疾病 (CVD)、癌症、死亡率、住院和卫生保健利用。次要结果是不良出生结局，如低出生体重和早产。使用随机效应荟萃分析来估计汇总优势比 (OR) 和 95%置信区间。
在 4952 条记录中，最终分析纳入了 144 项人群层面的研究；其中 126 项研究（87.5%）质量较高或中等。最常报告的政策是无烟立法（126 项研究），其次是税收或价格上涨（14 项研究）、多组分烟草控制计划（12 项研究）和最低香烟购买年龄法（1 项研究）。无烟立法与所有 CVD 事件（OR，0.90；95%CI，0.86-0.94）、RSD 事件（OR，0.83；95%CI，0.72-0.96）、因 CVD 或 RSD 住院的风险降低相关（OR，0.91；95%CI，0.87-0.95）以及不良出生结局（OR，0.94；95%CI，0.92-0.96）。这些关联在所有敏感性和亚组分析中均成立，但在国家收入类别中除外，在高收入国家仅观察到显著降低。在荟萃分析中，税收或价格上涨与不良健康结果之间没有明确的关联。然而，对于叙述性综合分析，所有 8 项研究都报告了税收增加与不良健康事件减少之间存在统计学显著关联。
在这项系统评价和荟萃分析中，无烟立法与 CVD、RSD 和围产期结局相关的发病率和死亡率显著降低有关。这些发现支持加快实施无烟法律的必要性，以保护人群免受吸烟相关危害。
