Introduction of Smoke-Free Legislation in England Has Led to Decreased COPD Emergency Admissions in Men, but not in Women

Abstract

The objective of this article is to assess the impact of the smoke-free legislation implemented from 2007 on emergency hospital admissions among patients with chronic obstructive pulmonary disease (COPD) in England. A time series design involving routinely collected hospital episode statistics data was employed. Ecological analyses were conducted using Poisson regression to evaluate whether annual emergency admissions among COPD patients changed following the introduction of the UK smoking-ban legislation in 2007. The analysis was based on aggregated hospital episodes statistics (HES) data for the financial years 2002/03 to 2011/2012, representing the five-year periods before and after the legislation. Setting England. All patients aged 40 or older with an emergency admission coded with a diagnosis of COPD. Main outcome measures Annual number of completed emergency hospital admissions. The pattern of emergency admissions for COPD differed between men and women in the periods before and after the introduction of the smoking ban legislation. After adjusting for variation in population size, age and population smoking prevalence, a statistically significant reduction in emergency admissions among men in the years after the ban was observed when compared with the corresponding period prior to the ban- having declined by 9% (95% CI: 7% - 12%; P< 0.01). In contrast, levels remained unchanged for women over the study period. Emergency admissions for COPD remained unchanged in women but declined among men by as much as 9% in the five years after the introduction of smoke-free legislation in England.