ABSTRACT Introduction Smoking and secondhand smoke pose major global health risks, contributing to Chronic Obstructive Pulmonary Disease (COPD). Evidence on the health impact of Shanghai’s smoke-free legislation is limited. This study assesses the effects of Shanghai’s smoke-free legislation on COPD hospital admission and mortality rates. Methods COPD hospital admissions and deaths from July 2013 to December 2019 were analyzed using interrupted time series. Adjustments were made for demographics, weather, PM2.5, and seasonality. Results A total of 358 941 COPD hospital admissions and 56 824 deaths were recorded. After implementation of the legislation, there was no evidence of a short-term reduction in either COPD hospital admissions or mortality among adults aged ≥35 years. Both COPD hospital admissions and mortality showed downward trends over the longer term, although these overall changes were not statistically significant. Subgroup analysis revealed a modest but statistically significant long-term decline in admissions among adults aged 35-64 years (β = −0.06, p.05), while no statistically significant short-term mortality change was observed among adults aged ≥65 years. Age-standardized analyses and Poisson and negative binomial sensitivity models yielded similar admission trends and broadly consistent long-term mortality patterns. Conclusions The implementation of the legislation was associated with a long-term downward trend in COPD-related hospital admissions and mortality, but the overall impact to date appears to be limited. Sustained implementation of stringent tobacco control policies is therefore recommended, alongside further improvement and expansion of existing measures to strengthen enforcement and broaden interventions, especially for outdoor smoking, to achieve greater health benefits.
Sun et al. (Thu,) studied this question.
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