Effects of a Smoke-Free Policy in Xi'an, China: Impact on Hospital Admissions for Acute Ischemic Heart Disease and Stroke.

Background: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2022 Chu, Liu, Fang, Wu, Liu, Zhao, Zhang, Wu and Tan.)