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Original research
Impact of smoke-free legislation on acute myocardial infarction and stroke mortality: Tianjin, China, 2007–2015
  1. Hong Xiao1,
  2. Hui Zhang2,
  3. Dezheng Wang2,
  4. Chengfeng Shen2,
  5. Zhongliang Xu2,
  6. Ying Zhang2,
  7. Guohong Jiang2,
  8. Gonghuan Yang3,
  9. Xia Wan3,
  10. Mohsen Naghavi4
  1. 1 Department of Global Health, University of Washington, Seattle, Washington, USA
  2. 2 Tianjin Centers for Disease Control and Prevention, Tianjin, China
  3. 3 Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, China
  4. 4 Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
  1. Correspondence to Professor Guohong Jiang, Tianjin Centers for Disease Control and Prevention, Tianjin, China; jiangguohongtjcdc{at}126.com and Professor Gonghuan Yang and Professor Xia Wan, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China; yangghuan{at}vip.sina.com, xiawan{at}ibms.pumc.edu.cn

Abstract

Background Smoke-free legislation is an effective way to protect the population from the harms of secondhand smoke and has been implemented in many countries. On 31 May 2012, Tianjin became one of the few cities in China to implement smoke-free legislation. We investigated the impact of smoke-free legislation on mortality due to acute myocardial infarction (AMI) and stroke in Tianjin.

Methods An interrupted time series design adjusting for underlying secular trends, seasonal patterns, population size changes and meteorological factors was conducted to analyse the impact of the smoke-free law on the weekly mortality due to AMI and stroke. The study period was from 1 January 2007 to 31 December 2015, with a 3.5-year postlegislation follow-up.

Results Following the implementation of the smoke-free law, there was a decline in the annual trends of AMI and stroke mortality. An incremental 16% (rate ratio (RR): 0.84; 95% CI: 0.83 to 0.85) decrease per year in AMI mortality and a 2% (RR: 0.98; 95% CI: 0.97 to 0.99) annual decrease in stroke mortality among the population aged ≥35 years in Tianjin was observed. Immediate postlegislation reductions in mortality were not statistically significant. An estimated 10 000 (22%) AMI deaths were prevented within 3.5 years of the implementation of the law.

Conclusion The smoke-free law in Tianjin was associated with reductions in AMI mortality. This study reinforces the need for large-scale, effective and comprehensive smoke-free laws at the national level in China.

  • secondhand smoke
  • Public policy
  • surveillance and monitoring
  • prevention

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tobaccocontrol-2018-054477

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    Footnotes

    • Contributors HX designed the study, contributed to data collection, completed the analysis and wrote the first draft of the manuscript. GhY and XW conceived the study, managed the data collection, supervised the analysis and contributed to the interpretation of the data. MN supervised the analysis and contributed to the interpretation of the data. GJ managed the data collection and contributed to the interpretation of result. HZ, DW, CS and YZ contributed to data collection. All authors contributed to and have approved the final manuscript.

    • Funding This research was supported by the China Medical Board (Strengthen Capacity of Study and Application on Burden of Disease in Health Care System of China – Establishment and Development of Chinese Burden of Disease Research and Dissemination Center [15-208]) and CAMS Innovation Fund for Medical Sciences (CIFMS) (2016-12M-3-001).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Presented at The abstract was accepted and presented in the 17th World Conference on Tobacco or Health. (Xiao H., Yang G., Wan X., Liu Y., Naghavi M. Impact of the smoke-free legislation on the incidence and mortality of AMI and stroke in Tianjin China: analysis of routinely collected data. Tobacco Induced Diseases. 2018;16(1):A160. doi:10.18332/tid/83971).

    • Patient consent for publication Not required.