Smoke-Free Policies and ۳۰-Day Mortality Rates for Chronic Obstructive Pulmonary Disease

Background  Smoke-free policies have been shown to impact ۳۰-day readmission rates due to chronic obstructive pulmonary disease (COPD) among adults aged ≥۶۵ years. However, little is known about the association between smokefree policies and ۳۰-day mortality rates for COPD. Therefore, we investigated the association between comprehensive smoke-free policies and ۳۰-day mortality rates for COPD. Methods  We used a cross-sectional study design and retrospectively examined risk-adjusted ۳۰- day mortality rates for COPD across US hospitals in ۱۱۷۱ counties. Data were sourced from Centers for Medicare and Medicaid Services (CMS) Hospital Value-Based Purchasing (HVBP) Program, American Hospital Association (AHA) Annual Surveys, US Census Bureau Current Population Survey, and US Tobacco Control Laws Database from the American Nonsmokers’ Rights Foundation (ANRF). Data were averaged at the county level for years ۲۰۱۵-۲۰۱۸. Hierarchical Poisson models adjusted for differences in hospital characteristics and accounted for the clustering of hospitals within a county were used.Results  Our findings show a consistent association between stronger smoke-free policies and a reduction in COPD mortality. When evaluating smoke-free policy, county characteristics, and hospital characteristics individually, we found that counties with full coverage or partial coverage had a reduced incidence rate of COPD mortality compared to no coverage counties. After adjusting for the county and hospital characteristics, counties with full coverage of smoke-free policies had a reduced rate of ۳۰-day COPD mortality (adjusted incidence rate ratio [IRR]: ۰.۸۷, ۹۵% CI: ۰.۷۹, ۰.۹۶) compared to counties with no policy coverage. Conclusion  Comprehensive smoke-free policies are associated with a reduction in ۳۰-day mortality following hospital admission for COPD. Partial smoke-free legislation is an insufficient preventative measure. These findings have strong implications for hospital policy- makers, suggesting that policy interventions to reduce COPD-related ۳۰-day mortality should include implementing smoke-free policies and public health policy-makers to incentivize comprehensive smokefree policies.

Keywords:

Smokefree Policies , COPD , ۳۰-Day , Mortality , Secondhand , Obstructive Pulmonary Disease