Smoke-Free Policies and 30-Day Mortality Rates for Chronic Obstructive Pulmonary Disease.

Emma Apatu,Aaron Spaulding,Hanadi Hamadi,Breck Peterson,Sericea Stallings-Smith

doi:10.34172/ijhpm.2021.74

Abstract

Smoke-free policies have been shown to impact 30-day readmission rates due to chronic obstructive pulmonary disease (COPD) among adults aged ≥65 years. However, little is known about the association between smokefree policies and 30-day mortality rates for COPD. Therefore, we investigated the association between comprehensive smoke-free policies and 30-day mortality rates for COPD. We used a cross-sectional study design and retrospectively examined risk-adjusted 30-day mortality rates for COPD across US hospitals in 1171 counties. Data were sourced from Centers for Medicare and Medicaid Services (CMS) Hospital Value-Based Purchasing (HVBP) Program, American Hospital Association (AHA) Annual Surveys, US Census Bureau Current Population Survey, and US Tobacco Control Laws Database from the American Nonsmokers' Rights Foundation (ANRF). Data were averaged at the county level for years 2015-2018. Hierarchical Poisson models adjusted for differences in hospital characteristics and accounted for the clustering of hospitals within a county were used. Our findings show a consistent association between stronger smoke-free policies and a reduction in COPD mortality. When evaluating smoke-free policy, county characteristics, and hospital characteristics individually, we found that counties with full coverage or partial coverage had a reduced incidence rate of COPD mortality compared to no coverage counties. After adjusting for the county and hospital characteristics, counties with full coverage of smoke-free policies had a reduced rate of 30-day COPD mortality (adjusted incidence rate ratio [IRR]: 0.87, 95% CI: 0.79, 0.96) compared to counties with no policy coverage. Comprehensive smoke-free policies are associated with a reduction in 30-day mortality following hospital admission for COPD. Partial smoke-free legislation is an insufficient preventative measure. These findings have strong implications for hospital policy-makers, suggesting that policy interventions to reduce COPD-related 30-day mortality should include implementing smoke-free policies and public health policy-makers to incentivize comprehensive smokefree policies.

Highlights

Chronic obstructive pulmonary disease (COPD) is a slowly progressive, non-reversible lung disease that includes chronic bronchitis, emphysema, and refractory asthma.[1]
The association between secondhand smoke exposure and chronic obstructive pulmonary disease (COPD) mortality has not been extensively examined, a study conducted in the Republic of Ireland demonstrated an immediate 38% reduction in COPD mortality following the implementation of a national smokefree policy with the most predominant effects occurring among females and those aged ≥65 years.[17]
Concerning hospital characteristics, no coverage (NC) counties had fewer hospitals (2.24 NC, 3.42 partial coverage (PC), 3.91 full coverage. Source (FC)), a lower number of beds (315.84 NC, 591.67 PC, 686.07, FC), fewer system hospitals (2.21 NC, 3.39 PC, 3.88 FC), fewer teaching hospitals (0.84 NC, 1.44 PC, 1.78 FC), a lower percentage of not-for-profit hospitals (46.48 NC, 59.91 PC, 68.59 FC), and fewer tobacco services offered by hospitals (0.84 NC, 1.39 PC, 1.50 FC)

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is a slowly progressive, non-reversible lung disease that includes chronic bronchitis, emphysema, and refractory asthma.[1]. A study has observed an association between secondhand smoke exposure in childhood and increased COPD mortality (hazard ratio = 1.31; 95% CI: 1.05-1.65) among never smokers.[16] Another study identified similar COPD prevalence among active and non-smokers within the same geographic area, suggesting a relationship between regions, secondhand smoke, and smokefree policies.[7] the association between secondhand smoke exposure and COPD mortality has not been extensively examined, a study conducted in the Republic of Ireland demonstrated an immediate 38% reduction in COPD mortality following the implementation of a national smokefree policy with the most predominant effects occurring among females and those aged ≥65 years.[17] A follow-up study further determined that these all-cause and COPD-related mortality reductions were concentrated among those with the lowest socioeconomic status.[18] Since active smoking prevalence did not appreciably change during this period, it was determined that the observed mortality reductions were attributable to decreased exposure to secondhand smoke These two studies were deemed to have a low risk of bias in a meta-analysis of 50 articles regarding smoke-free legislation and respiratory disorders.[19]

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