Background

In Scotland, childhood admissions to hospital for asthma fell from March, 2006, after legislation was introduced to prohibit smoking in public places. In December, 2016, new Scottish legislation banned smoking in vehicles containing a child. We aimed to determine whether the introduction of this new legislation produced additional benefits.

Methods

We obtained data on all asthma emergency admissions to hospitals in Scotland between 2000 and 2018 for individuals younger than 16 years. We used interrupted time-series analyses to study changes in monthly incidence of asthma emergency admissions to hospital per 100 000 children after the introduction of smoke-free vehicle legislation, taking into account previous smoke-free interventions. We did subgroup analyses according to age and area deprivation, using the Scottish Index of Multiple Deprivation, and repeated the analyses for a control condition, gastroenteritis, and other respiratory conditions.

Findings

Of the 32 342 emergency admissions to hospital for asthma among children younger than 16 years over the 19-year study period (Jan 1, 2000, to Dec 31, 2018), 13 954 (43%) were among children younger than 5 years and 18 388 (57%) were among children aged 5–15 years. After the introduction of smoke-free vehicle legislation, there was a non-significant decline in the slope for monthly emergency admissions to hospital for asthma among children younger than 16 years (−1·21%, 95% CI −2·64 to 0·23) relative to the underlying trend in hospital admissions for childhood asthma. However, children younger than 5 years had a significant decline in the slope for monthly asthma admissions (−1·49%, −2·69 to −0·27) over and above the underlying trend among children in this age group (equivalent to six fewer hospitalisations per year), but no such decline was seen in children aged 5–15 years. Monthly admissions to hospital for asthma fell significantly among children living in the most affluent areas (−2·27%, −4·41 to −0·07) but not among those living in the most deprived areas. We found no change in admissions to hospital for gastroenteritis or other respiratory conditions after the introduction of the smoke-free vehicle legislation.

Interpretation

Although legislation banning smoking in vehicles did not affect hospital admissions for severe asthma among children overall or in the older age group, this legislation was associated with a reduction in severe asthma exacerbations requiring hospital admission among preschool children, over and above the underlying trend and previous interventions designed to reduce exposure to second-hand smoke. Similar legislation prohibiting smoking in vehicles that contain children should be adopted in other countries.

Funding

None.

中文翻译：

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苏格兰无烟车辆立法与儿童因哮喘入院的关联：对全人群数据的中断时间序列分析

背景

在苏格兰，在立法禁止在公共场所吸烟后，儿童因哮喘入院的人数从 2006 年 3 月开始下降。2016 年 12 月，新的苏格兰立法禁止在载有儿童的车辆内吸烟。我们旨在确定这项新立法的引入是否会产生额外的好处。

方法

我们获得了 2000 年至 2018 年苏格兰医院所有 16 岁以下哮喘患者急诊入院的数据。我们使用间断时间序列分析来研究引入无烟车辆立法后每 100 000 名儿童哮喘急诊入院的月发病率变化，同时考虑到以前的无烟干预措施。我们根据年龄和面积剥夺，使用苏格兰多重剥夺指数进行亚组分析，并针对对照条件、胃肠炎和其他呼吸系统条件重复分析。

发现

在 19 年的研究期间（2000 年 1 月 1 日至 2018 年 12 月 31 日）中，32342 名 16 岁以下儿童因哮喘急诊入院，其中 13954 名（43%）为 5 岁以下儿童和18 388 (57%) 名年龄在 5-15 岁之间的儿童。引入无烟车辆立法后，16 岁以下儿童因哮喘急诊入院的每月斜率没有显着下降（-1·21%，95% CI -2·64 至 0 ·23) 相对于儿童哮喘住院的潜在趋势。然而，5 岁以下儿童的每月哮喘入院斜率（-1·49%，-2·69 至 -0·27）显着下降，超过了该年龄组儿童的潜在趋势（相当于每年减少六次住院），但在 5-15 岁的儿童中没有看到这种下降。生活在最富裕地区（-2·27%，-4·41 至 -0·07）的儿童因哮喘入院的月度住院率显着下降，但生活在最贫困地区的儿童中则没有。在引入无烟车辆立法后，我们发现因肠胃炎或其他呼吸系统疾病入院的人数没有变化。

解释

尽管禁止在车内吸烟的立法并没有影响整个儿童或老年组儿童因严重哮喘住院的情况，但该立法与学龄前儿童需要住院的严重哮喘恶化的减少有关，超出了基本趋势和先前的趋势。旨在减少接触二手烟的干预措施。其他国家也应采用类似的立法，禁止在载有儿童的车辆内吸烟。

资金

没有任何。