Shi Yulin, Peng Ji, Liu Liqun, Zhao Zhiguang, Xiong Jingfan, Wan Xia
Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.
Shenzhen Center for Disease Control and Prevention, Shenzhen, China.
Tob Induc Dis. 2023 Aug 1;21:100. doi: 10.18332/tid/168123. eCollection 2023.
The Shenzhen government is widely considered to be most efficiently implementing smoke-free legislation in China. We evaluated and compared the impact of Shenzhen's two-phase smoke-free regulation on the incidence rates for ischemic and hemorrhagic stroke.
An interrupted time series design was used to capture immediate and annual incidence changes from 2007 to 2016 for both ischemic and hemorrhagic stroke due to two-phase smoke-free regulation in Shenzhen, China, by using a generalized additive model. The first phase, implemented on 9 March 2010, required five main public places to be smoke-free. In the second phase, the comprehensive law was expanded to the whole city on 1 March 2014.
The regulation implementation during phase I was associated with a strong immediate decline in the incidence rate of ischemic stroke (-14.2%, 95% CI: -19.6 - -8.4) and hemorrhagic stroke (-10.1%, 95% CI: -18.2 - -1.2), but without showing the annual changes (p>0.05). Following the implementation of the comprehensive law, the gradual annual effect showed a significant change in ischemic stroke, with a 6.3% (95% CI: 8.9 - -3.6) reduction. Neither the immediate nor gradual decreases in hemorrhagic stroke incidences associated with the comprehensive regulation were statistically significant during phase II (p>0.05). Subgroup analyses indicate that a much larger health effect of the regulation during phase I was greater among those aged ≥65 years than among those aged 35-64 years.
Shenzhen's two-phase smoke-free regulation was well implemented. Even though the regulation did not extend to the whole city, the immediate health benefits on the incidence rates of ischemic stroke and hemorrhagic stroke could be seen. However, the health benefits brought by the implementation of comprehensive smoke-free legislation were attenuated by previous smoke-free regulations in five main public places, which were more evident in hemorrhagic stroke.
深圳政府被广泛认为是中国最有效实施无烟立法的城市。我们评估并比较了深圳两阶段无烟法规对缺血性和出血性中风发病率的影响。
采用中断时间序列设计，通过广义相加模型，获取2007年至2016年中国深圳两阶段无烟法规导致的缺血性和出血性中风的即时和年度发病率变化。第一阶段于2010年3月9日实施，要求五个主要公共场所无烟。第二阶段，综合法律于2014年3月1日扩展至全市。
第一阶段的法规实施与缺血性中风发病率的强烈即时下降（-14.2%，95%置信区间：-19.6至-8.4）和出血性中风发病率的下降（-10.1%，95%置信区间：-18.2至-1.2）相关，但未显示年度变化（p>0.05）。综合法律实施后，缺血性中风的逐年影响逐渐显现出显著变化，下降了6.3%（95%置信区间：8.9至-3.6）。在第二阶段，与综合法规相关的出血性中风发病率的即时或逐年下降均无统计学意义（p>0.05）。亚组分析表明，第一阶段法规对65岁及以上人群的健康影响远大于35-64岁人群。
深圳的两阶段无烟法规得到了有效实施。尽管该法规并未扩展至全市，但对缺血性中风和出血性中风发病率的即时健康益处是可见的。然而，五个主要公共场所先前的无烟法规削弱了全面无烟立法实施带来的健康益处，这在出血性中风中更为明显。
