Impact of comprehensive tobacco control policies on stroke and acute myocardial infarction among patients with hypertension and type 2 diabetes in Beijing, China: An interrupted time-series analysis.

BACKGROUND AND AIMS: Tobacco control policies enhance cardiovascular health at the population level, but their effects on high-risk individuals, such as those with type 2 diabetes mellitus (T2DM) or hypertension, remain unclear. This study evaluated the association between a tobacco control policy and hospital admissions for stroke and acute myocardial infarction (AMI) in hypertensive and T2DM individuals.

DESIGN

Interrupted time series study.

SETTING

Beijing, China.

PARTICIPANTS

2 144 133 hypertensive and 1 446 750 T2DM patients residing in Beijing from January 2013 to June 2017.

INTERVENTION: A comprehensive tobacco control policy package, incorporating all MPOWER components, was implemented in June 2015.

MEASUREMENTS: Changes in admission rates and admissions for stroke and AMI.

FINDINGS: Patients with T2DM showed immediate decreases in stroke [-9.4% (95% confidence interval = -13.3% to -5.3%)] and AMI [-24.3% (-31.2% to -16.7%)] admission rates after the policy. Similarly, the immediate post-policy change in stroke and AMI admission rates for hypertensive patients was -7.5% (-10.9% to -3.9%) and -23.0% (-29.2% to -16.3%), respectively. However, these reductions did not differ from those without either condition (P-interaction >0.05). For long-term trends, significant decreases were only seen for stroke [T2DM: -32.9% (-39.9% to -25.1%); hypertension: -33.3% (-39.3% to -26.7%)], but not AMI admissions, and again did not differ from those without either disease (P-interaction >0.05). Compared with healthy controls without T2DM or hypertension, patients with both conditions showed greater long-term reductions in stroke admission rates [-29.2% (-37.0% to -20.5%) vs. -14.4% (-26.3% to -0.5%), P-interaction = 0.05), whereas the opposite trend was observed for AMI admissions [7.9% (-15.9% to 38.4%) vs. -29.9% (-46.9% to -7.3%), P-interaction = 0.02].

CONCLUSIONS

Beijing's 2015 comprehensive tobacco control policy appears to be associated with reduced acute myocardial infarction and stroke admissions among high-risk groups (individuals with type 2 diabetes mellitus and hypertension), although admission rates showed no statistically significant difference between high-risk and non-high-risk populations.