Impact of the tobacco law on hospitalizations for tobacco-related diseases in adults in Portugal

Abstract

Abstract Introduction Tobacco contributes to about 8 million deaths per year worldwide, of which 1.2 million are due to passive exposure to tobacco smoke, according to WHO data. Ambitious anti-tobacco policies have been implemented in European countries, but few have been evaluated. The present research measures the impact of the anti-tobacco laws implemented in Portugal in 2007, and reinforced in 2015, in the adult population residing in Portugal, between January 1, 2002 and December 31, 2018. Methods We used data for all in-patient stays at all public hospitals over the 2002-2018 period. A quasi-experimental interrupted time series study was applied, considering the years 2008 and 2016 as exogenous shocks. The dependent variables under study are the incidence of hospitalizations by municipality of residence and year for tobacco-related diseases, namely: AMS, stroke, lower respiratory tract infections, COPD and asthma. We adjusted the analysis by the percentage of women, percentage of people aged >65, and purchasing power. We produced time trend graphs for each variable, with subsequent adjustment to the Poisson regression model to predict its evolution. A comparison was made between the values observed after the implementation of the law and its reformulation and the values projected based on the regression model selected, to identify the percentage difference between the two. Expected Results In line with the international literature, a generalized decrease in the incidence of hospitalizations for tobacco-related diseases was observed after the implementation of the tobacco law. Likewise, after the changes added in its reformulation, the reduction in incidence was stronger, although not as sharply, compared to 2007. Conclusions Anti-tobacco laws in Portugal have been effective in reducing tobacco-related hospitalizations, with expected gains in life expectancy and reduced burden for the health system. Key messages • Tobacco contributes to about 8 million deaths per year worldwide, of which 1.2 million are due to passive exposure to tobacco smoke. • Generalized decrease in the incidence of hospitalizations for tobacco-related diseases was observed after the implementation of the tobacco law.