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dc.contributor.authorGalan, Iñaki 
dc.contributor.authorSimon Mendez, Lorena 
dc.contributor.authorBoldo, Elena 
dc.contributor.authorOrtiz Burgos, Cristina 
dc.contributor.authorFernandez-Cuenca , Rafael 
dc.contributor.authorLinares-Gil, Cristina 
dc.contributor.authorMedrano, Maria Jose 
dc.contributor.authorPastor-Barriuso, Roberto
dc.identifier.citationPLoS One. 2017 May 24;12(5):e0177979.es_ES
dc.description.abstractBACKGROUND: Existing evidence on the effects of smoke-free policies on respiratory diseases is scarce and inconclusive. Spain enacted two consecutive smoke-free regulations: a partial ban in 2006 and a comprehensive ban in 2011. We estimated their impact on hospital admissions via emergency departments for chronic obstructive pulmonary disease (COPD) and asthma. METHODS: Data for COPD (ICD-9 490-492, 494-496) came from 2003-2012 hospital admission records from the fourteen largest provinces of Spain and from five provinces for asthma (ICD-9 493). We estimated changes in hospital admission rates within provinces using Poisson additive models adjusted for long-term linear trends and seasonality, day of the week, temperature, influenza, acute respiratory infections, and pollen counts (asthma models). We estimated immediate and gradual effects through segmented-linear models. The coefficients within each province were combined through random-effects multivariate meta-analytic models. RESULTS: The partial ban was associated with a strong significant pooled immediate decline in COPD-related admission rates (14.7%, 95%CI: 5.0, 23.4), sustained over time with a one-year decrease of 13.6% (95%CI: 2.9, 23.1). The association was consistent across age and sex groups but stronger in less economically developed Spanish provinces. Asthma-related admission rates decreased by 7.4% (95%CI: 0.2, 14.2) immediately after the comprehensive ban was implemented, although the one-year decrease was sustained only among men (9.9%, 95%CI: 3.9, 15.6). CONCLUSIONS: The partial ban was associated with an immediate and sustained strong decline in COPD-related admissions, especially in less economically developed provinces. The comprehensive ban was related to an immediate decrease in asthma, sustained for the medium-term only among men.es_ES
dc.description.sponsorshipThis work was supported by Grant FIS PI11/01276 from the Institute of Health Carlos III, Ministry of Economy and Competitiveness. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.es_ES
dc.publisherPublic Library of Science (PLOS) es_ES
dc.subject.meshAsthma es_ES
dc.subject.meshEmergency Service, Hospital es_ES
dc.subject.meshFemale es_ES
dc.subject.meshHospitalization es_ES
dc.subject.meshHumans es_ES
dc.subject.meshMale es_ES
dc.subject.meshPulmonary Disease, Chronic Obstructive es_ES
dc.subject.meshSmoke-Free Policy es_ES
dc.subject.meshSmoking es_ES
dc.subject.meshSpain es_ES
dc.titleChanges in hospitalizations for chronic respiratory diseases after two successive smoking bans in Spaines_ES
dc.typejournal articlees_ES
dc.rights.licenseAtribución 4.0 Internacional*
dc.contributor.funderInstituto de Salud Carlos III 
dc.identifier.journalPloS onees_ES
dc.repisalud.centroISCIII::Centro Nacional de Epidemiologíaes_ES
dc.repisalud.centroISCIII::Escuela Nacional de Sanidad
dc.rights.accessRightsopen accesses_ES

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