Effect of comprehensive smoke-free legislation on neonatal mortality and infant mortality across 106 middle-income countries: a synthetic control study

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Effect of comprehensive smoke-free legislation on neonatal mortality and infant mortality across 106 middle-income countries : a synthetic control study

Rado, Marta (författare): Linköpings universitet,Institutet för analytisk sociologi, IAS,Filosofiska fakulteten,Univ Med Ctr Rotterdam, Netherlands; Univ Med Ctr Rotterdam, Netherlands

van Lenthe, Frank J. (författare): Univ Med Ctr Rotterdam, Netherlands

Laverty, Anthony A. (författare): Imperial Coll London, England

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Filippidis, Filippos T. (författare): Imperial Coll London, England

Millett, Christopher (författare): Imperial Coll London, England; NOVA Univ Lisbon, Portugal; Comprehens Hlth Res Ctr, Portugal

Sheikh, Aziz (författare): Univ Edinburgh, Scotland

Been, Jasper V (författare): Univ Med Ctr Rotterdam, Netherlands; Univ Med Ctr Rotterdam, Netherlands; Univ Edinburgh, Scotland

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Elsevier Science Ltd, 2022
2022
Engelska.
Ingår i: The Lancet Public Health. - : Elsevier Science Ltd. - 2468-2667. ; 7:7, s. E616-E625

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Background There are few quantitative studies into the effect of comprehensive smoke-free legislation on neonatal and infant mortality in middle-income countries. We aimed to estimate the effects of implementing comprehensive smoke-free legislation on neonatal mortality and infant mortality across all middle-income countries. Methods We applied the synthetic control method using 1990-2018 country-level panel data for 106 middle-income countries from the WHO, World Bank, and Penn World datasets. Outcome variables were neonatal (age 0-28 days) mortality and infant (age 0-12 months) mortality rates per 1000 livebirths per year. For each middle-income country with comprehensive smoke-free legislation, a synthetic control country was constructed from middle-income countries without comprehensive smoke-free legislation, but with similar prelegislation trends in the outcome and predictor variables. Overall legislation effect was the mean average of country-specific effects weighted by the number of livebirths. We compared the distribution of the legislation effects with that of the placebo effects to assess the likelihood that the observed effect was related to the implementation of smoke-free legislation and not merely influenced by other processes. Findings 31 (29%) of 106 middle-income countries introduced comprehensive smoke-free legislation and had outcome data for at least 3 years after the intervention. We were able to construct a synthetic control country for 18 countries for neonatal mortality and for 15 countries for infant mortality. Comprehensive smoke-free legislation was followed by a mean yearly decrease of 1.63% in neonatal mortality and a mean yearly decrease of 1.33% in infant mortality. An estimated 12 392 neonatal deaths in 18 countries and 8932 infant deaths in 15 countries were avoided over 3 years following the implementation of comprehensive smoke-free legislation. We estimated that an additional 104 063 infant deaths (including 95 850 neonatal deaths) could have been avoided over 3 years if the 72 control middle-income countries had introduced this legislation in 2015. 220 (43%) of 514 placebo effects for neonatal mortality and 112 (39%) of 289 for infant mortality were larger than the estimated aggregated legislation effect, indicating a degree of uncertainty around our estimates. Sensitivity analyses showed results that were consistent with the main analysis and suggested a dose-response association related to comprehensiveness of the legislation. Interpretation Implementing comprehensive smoke-free legislation in middle-income countries could substantially reduce preventable deaths in neonates and infants. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.

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MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)

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