title: Smoke-free legislation and childhood hospitalisations for respiratory tract infections.
abstract: 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.
authors.affiliation: School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK Dept of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands Division of Neonatology, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands jasper.been@mumc.nl.
authors.forename: Jasper V
authors.initials: JV
authors.lastname: Been
authors.affiliation: Dept of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Millett
authors.affiliation: Dept of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
authors.forename: John Tayu
authors.initials: JT
authors.lastname: Lee
authors.affiliation: School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
authors.forename: Constant P
authors.initials: CP
authors.lastname: van Schayck
authors.affiliation: School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D010343:Patient Admission / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D014028:Tobacco Smoke Pollution / Q000009:adverse effects / Q000331:legislation & jurisprudence*; D006113:United Kingdom
chemical_list: D014028:Tobacco Smoke Pollution