Impact of smoke-free legislation on perinatal and infant mortality: a national quasi-experimental study.
Smoke-free legislation is associated with improved early-life outcomes; however its impact on perinatal survival is unclear. We linked individual-level data with death certificates for all registered singletons births in England (1995-2011). We used interrupted time series logistic regression analysis to study changes in key adverse perinatal events following the July 2007 national, comprehensive smoke-free legislation. We studied 52,163 stillbirths and 10,238,950 live-births. Smoke-free legislation was associated with an immediate 7.8% (95%CI 3.5-11.8; p < 0.001) reduction in stillbirth, a 3.9% (95%CI 2.6-5.1; p < 0.001) reduction in low birth weight, and a 7.6% (95%CI 3.4-11.7; p = 0.001) reduction in neonatal mortality. No significant impact on SIDS was observed. Using a counterfactual scenario, we estimated that in the first four years following smoke-free legislation, 991 stillbirths, 5,470 cases of low birth weight, and 430 neonatal deaths were prevented. In conclusion, smoke-free legislation in England was associated with clinically important reductions in severe adverse perinatal outcomes.
1] Division of Neonatology, Erasmus University Medical Centre - Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, Netherlands [2] Department of Paediatrics, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, Netherlands.
Jasper V
JV
Been
Centre for Population and Health Sciences, University of Glasgow, Glasgow G12 8RZ, United Kingdom.
Daniel F
DF
Mackay
Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, United Kingdom.
Christopher
C
Millett
Centre for Population and Health Sciences, University of Glasgow, Glasgow G12 8RZ, United Kingdom.
Jill P
JP
Pell
1] Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh EH8 9AG, United Kingdom [2] School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, Netherlands.
Onno C P
OC
van Schayck
1] Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh EH8 9AG, United Kingdom [2] School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, Netherlands [3] Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston MA 02120, USA [4] Department of Medicine, Harvard Medical School, Boston MA 02115, USA.
Aziz
A
Sheikh
D004739:England; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D054238:Perinatal Mortality; D011247:Pregnancy; D061845:Smoke-Free Policy / Q000331:legislation & jurisprudence*; D012907:Smoking / Q000009:adverse effects