1. Changes in hospitalizations for chronic respiratory diseases after two successive smoking bans in Spain
- Author
-
Cristina Linares, Rafael Fernández-Cuenca, Iñaki Galán, Elena Boldo, Roberto Pastor-Barriuso, Lorena Simón, Cristina Ortiz, María José Medrano, Instituto de Salud Carlos III, UAM. Departamento de Medicina Preventiva y Salud Pública y Microbiología, and Instituto de Investigación Sanitaria Hospital Universitario de La Paz (IdiPAZ)
- Subjects
Male ,Viral Diseases ,Respiratory diseases ,Pulmonology ,Social Sciences ,lcsh:Medicine ,Plant Science ,Smoke-Free Policy ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Medicine and Health Sciences ,Decrease in asthma ,Public and Occupational Health ,030212 general & internal medicine ,lcsh:Science ,health care economics and organizations ,Multidisciplinary ,Plant Anatomy ,Smoking ,Poisson ,Hospitals ,humanities ,Hospitalization ,Infectious Diseases ,Work (electrical) ,Pollen ,Christian ministry ,Female ,Medical emergency ,Emergency Service, Hospital ,Research Article ,Tobacco Control ,Medicina ,Chronic Obstructive Pulmonary Disease ,Smoke-free policies ,03 medical and health sciences ,medicine ,Humans ,Regulations ,Asthma ,business.industry ,lcsh:R ,Biology and Life Sciences ,medicine.disease ,Influenza ,Health Care ,030228 respiratory system ,Health Care Facilities ,Spain ,Respiratory Infections ,Law and Legal Sciences ,Changes in hospitalizations ,lcsh:Q ,business ,Smoking Legislation - Abstract
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Existing evidence on the effects of smoke-free policies on respiratory diseases is scarce and inconclusive. Spain enacted two consecutive smoke-free regulations: a partial ban in 2006 and a comprehensive ban in 2011. We estimated their impact on hospital admissions via emergency departments for chronic obstructive pulmonary disease (COPD) and asthma. Methods Data for COPD (ICD-9 490-492, 494-496) came from 2003-2012 hospital admission records from the fourteen largest provinces of Spain and from five provinces for asthma (ICD-9 493). We estimated changes in hospital admission rates within provinces using Poisson additive models adjusted for long-term linear trends and seasonality, day of the week, temperature, influenza, acute respiratory infections, and pollen counts (asthma models). We estimated immediate and gradual effects through segmented-linear models. The coefficients within each province were combined through random-effects multivariate meta-analytic models. Results The partial ban was associated with a strong significant pooled immediate decline in COPDrelated admission rates (14.7%, 95%CI: 5.0, 23.4), sustained over time with a one-year decrease of 13.6% (95%CI: 2.9, 23.1). The association was consistent across age and sex groups but stronger in less economically developed Spanish provinces. Asthma-related admission rates decreased by 7.4% (95%CI: 0.2, 14.2) immediately after the comprehensive ban was implemented, although the one-year decrease was sustained only among men (9.9%, 95%CI: 3.9, 15.6). Conclusions The partial ban was associated with an immediate and sustained strong decline in COPDrelated admissions, especially in less economically developed provinces. The comprehensive ban was related to an immediate decrease in asthma, sustained for the medium-term only among men, This work was supported by Grant FIS PI11/01276 from the Institute of Health Carlos III, Ministry of Economy and Competitiveness
- Published
- 2017