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

Abstract

BackgroundSmoking 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.MethodsAll 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.ResultsThe 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.ConclusionThe 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.

Health effects associated with exposure to secondhand smoke: a Burden of Proof study

“…As outlined by the World Health Organization, smoke-free policies in combination with strategies promoting active smoking cessation and noninitiation are among the most effective tobacco control interventions to reduce passive smoking and protect health 454 . Studies of the effects of smoke-free laws found that hospital admission and mortality rates for cardiovascular and respiratory conditions decreased after the implementation of smoking bans [455][456][457][458][459] . However, comprehensive smoke-free legislation (that is, covering all indoor public places) is in place in only 67 countries, protecting less than 25% of the world's population 7 .…”

Advances in Stroke: A Focus on Health Policy Literature From 2022

“…A study on the 2018 smoke-free policy in Xi’an, China found a 16% reduction in stroke admissions across 6 hospitals after the policy was implemented. 8 Disseminating the findings to local decision-makers is critical for change.…”