BACKGROUND: Smoking and secondhand smoke are major global health threats, significantly contributing to the burden of chronic obstructive pulmonary disease (COPD). Despite the implementation of tobacco control policies worldwide, limited evidence exists on the health impacts in Shanghai. This study evaluates the effects of Shanghai’s 2017 smoke-free regulation on COPD hospital admission and mortality rates.
METHODS: Data on COPD-related hospital admissions and deaths in Shanghai from July 2013 to December 2021 were analyzed. Interrupted time series analysis was used to assess the trends in hospital admission and mortality rates following the implementation of the Regulations. Adjustments were made for population structure based on Shanghai 2013 demographic data, and sensitivity analyses were conducted to control for confounding factors, including temperature, humidity, PM2.5 levels, and seasonality.
RESULTS: A total of 402912 COPD hospital admissions and 71922 deaths were recorded during the study period. Following the implementation of the Regulations, the long-term effect on hospital admission rates showed a significant decline (β = -0.51, p < 0.01), preventing an estimated 622 hospital admissions annually among residents aged 35 years and older. Although the short- and long-term effects on mortality rates showed a downward trend（β_short＝-0.59，ｐ＞0.05; β_long＝-0.015，ｐ＞0.05）, the changes were minimal and not statistically significant. Subgroup analysis showed that the population aged 65 years and above exhibited a more pronounced decreasing trend in long-term admission rates (β = -1.20, p <0.05) and short-term mortality rates (β = -2.16, p > 0.05).Population-standardized results and sensitivity analyses aligned with baseline trends, with significant findings observed only in the Poisson model.
CONCLUSIONS: This study provides valuable evidence on the health benefits of the Shanghai Tobacco Control Regulations. The implementation of the Regulations significantly reduced hospital admission rates among COPD patients, although the impact on mortality rates was limited.