Smoke-free legislation and childhood hospitalisations for respiratory tract infections

• Published in: The European respiratory journal Vol. 46; no. 3; pp. 697 - 706
• Main Authors: Been, Jasper V., Millett, Christopher, Lee, John Tayu, van Schayck, Constant P., Sheikh, Aziz
• Format: Journal Article
• Language: English
• Published: England 01.09.2015
• Subjects: Adolescent; Age Distribution; Child; Child, Preschool; Databases, Factual; Female; Hospitalization - statistics & numerical data; Humans; Incidence; Male; Multivariate Analysis; Patient Admission - statistics & numerical data; Regression Analysis; Respiratory Tract Infections - diagnosis; Respiratory Tract Infections - epidemiology; Respiratory Tract Infections - therapy; Retrospective Studies; Risk Assessment; Sex Distribution; Tobacco Smoke Pollution - adverse effects; Tobacco Smoke Pollution - legislation & jurisprudence; United Kingdom
• ISSN: 0903-1936; 1399-3003; 1399-3003
• DOI: 10.1183/09031936.00014615

Second-hand smoke exposure is a major risk factor for respiratory tract infections (RTIs). Although evidence suggests important early-life health benefits of smoke-free public environments, the impact on childhood RTIs is unclear. We investigated the association between England's smoke-free legislation and childhood RTI hospitalisations. We used the Hospital Episode Statistics database to obtain nationwide data on hospital admissions for acute RTIs among children (<15 years of age) from 2001 to 2012. Hospitalisation counts were disaggregated by month, age group, sex and small-area level, and linked to urbanisation, region, deprivation index and corresponding population estimates. Negative binomial regression analyses were adjusted for confounders, seasonal variation, temporal autocorrelation, population-size changes and underlying incidence trends. Models allowed for sudden and gradual changes following the smoke-free legislation. We performed sensitivity and subgroup analyses, and estimated number of events prevented. We analysed 1 651 675 hospital admissions. Introduction of smoke-free legislation was followed by an immediate reduction in RTI admissions (−3.5%, 95% CI −4.7– −2.3%), this mainly being attributable to a decrease in lower RTI admissions (−13.8%, 95% CI −15.6– −12.0%). The reductions in admissions for upper RTI were more incremental. The introduction of national smoke-free legislation in England was associated with ∼11 000 fewer hospital admissions per year for RTIs in children.