title: Smoke-free legislation and the incidence of paediatric respiratory infections and wheezing/asthma: interrupted time series analyses in the four UK nations.
abstract: We investigated the association between introduction of smoke-free legislation in the UK (March 2006 for Scotland, April 2007 for Wales and Northern Ireland, and July 2007 for England) and the incidence of respiratory diseases among children. We extracted monthly counts of new diagnoses of wheezing/asthma and RTIs among children aged 0-12 years from all general practices in the Clinical Practice Research Datalink during 1997-2012. Interrupted time series analyses were performed using generalised additive mixed models, adjusting for underlying incidence trends, population size changes, seasonal factors, and pandemic influenza, as appropriate. 366,642 new wheezing/asthma diagnoses and 4,324,789 RTIs were observed over 9,536,003 patient-years. There was no statistically significant change in the incidence of wheezing/asthma after introduction of smoke-free legislation in England (incidence rate ratio (IRR) 0.94, 95% CI 0.81-1.09) or any other UK country (Scotland: IRR 0.99, 95% CI 0.83-1.19; Wales: IRR 1.09, 95% CI 0.89-1.35; Northern Ireland: IRR 0.96, 95% CI 0.76-1.22). Similarly no statistically significant changes in RTI incidence were demonstrated (England: IRR 0.95, 95% CI 0.86-1.06; Scotland: IRR 0.96, 95% CI 0.83-1.11; Wales: IRR 0.97, 95% CI 0.86-1.09; Northern Ireland: IRR 0.90, 95% CI 0.79-1.03). There were no demonstrable reductions in the incidence of paediatric wheezing/asthma or RTIs following introduction of smoke-free legislation in the UK.
authors.affiliation: Division of Neonatology, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, Netherlands.|Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom.|Department of Paediatrics, Maastricht University Medical Centre, Maastricht, Netherlands.|School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands.
authors.forename: Jasper V
authors.initials: JV
authors.lastname: Been
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Division of Epidemiology and Public Health, Nottingham City Hospital, Nottingham, United Kingdom.
authors.forename: Lisa
authors.initials: L
authors.lastname: Szatkowski
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.|Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.
authors.forename: Tjeerd-Pieter
authors.initials: TP
authors.lastname: van Staa
authors.affiliation: Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.
authors.forename: Hubert G
authors.initials: HG
authors.lastname: Leufkens
authors.affiliation: Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom.|School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands.
authors.forename: Onno C
authors.initials: OC
authors.lastname: van Schayck
authors.affiliation: Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom.|School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands.|Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, USA.
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
authors.affiliation: School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands.|Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.|Department of Clinical Pharmacy &Toxicology, Maastricht University Medical Centre, Maastricht, the Netherlands.|MRC Epidemiology Lifecourse Unit, Southampton General Hospital, Southampton, United Kingdom.
authors.forename: Frank
authors.initials: F
authors.lastname: de Vries
authors.affiliation: Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.
authors.forename: Patrick
authors.initials: P
authors.lastname: Souverein
mesh_terms: D001249:Asthma / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D033161:Government Regulation; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012135:Respiratory Sounds; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D012307:Risk Factors; D061845:Smoke-Free Policy / Q000331:legislation & jurisprudence*; D014028:Tobacco Smoke Pollution / Q000331:legislation & jurisprudence* / Q000517:prevention & control* / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D014028:Tobacco Smoke Pollution