Effect of covering perinatal health-care costs on neonatal outcomes in Switzerland: a quasi-experimental population-based study

Effects of comprehensive smoke-free legislation on smoking behaviours and macroeconomic outcomes in Shanghai, China: a difference-in-differences analysis and modelling study

BACKGROUND

China has one of the highest levels of tobacco consumption globally, and there is no national smoke-free legislation. Although more than 20 Chinese cities have passed local smoke-free laws since 2008, evidence on their effectiveness in reducing smoking behaviours and their economic benefits is scarce. By exploiting a natural quasi-experiment, whereby a comprehensive public smoking ban was implemented in Shanghai in March, 2017, this study aims to assess the impact of the policy on individual smoking behaviours and quantify its effect on macroeconomic outcomes.

METHODS

In this difference-in-differences analysis and modelling study, we used data on smoking behaviours from the 2012, 2014, 2016, and 2018 waves of the China Family Panel Studies. We used a difference-in-differences approach to investigate trends in smoking prevalence in respondents in Shanghai, relative to respondents from other direct-administered municipalities, provincial capital cities, and subprovincial municipalities (control group), after the implementation of a smoking ban in 2017. All respondents aged 18 years or older were included, with the exception of people who lived in Beijing and rural areas. The primary variable of interest in the difference-in-differences analysis was self-reported smoking status. Based on the difference-in-differences estimation of reduction in smoking prevalence, we then used a health-augmented macroeconomic model to estimate the potential macroeconomic gains if such a ban was implemented across China for the period 2017-35.

FINDINGS

14 688 respondents were included in the analysis: 5766 from Shanghai and 8922 from the control group. After the implementation of the smoking ban in Shanghai in 2017, smoking prevalence decreased by 2·2 percentage points (95% CI 2·1-2·3), equivalent to an 8·4% reduction in the number of current smokers. The smoking ban had a larger effect on men, people with a higher level of education, unmarried people, and younger people when compared with their respective counterparts. The modelling analysis showed that implementing a nationwide comprehensive public smoking ban similar to that in Shanghai would result in a 0·04-0·07% increase in the national gross domestic product in China between 2017 and 2035, outweighing the economic costs of smoking ban enforcement.

INTERPRETATION

The smoking ban in Shanghai shows that a comprehensive public smoking ban with strict enforcement is effective in curbing smoking behaviours. Moreover, the implementation of a comprehensive public smoking ban across China would be cost-effective.

FUNDING

National Social Science Fund of China.

Analysis of the relationship between the quality of antenatal care examinations and the incidence of preterm birth and low birth weight

BACKGROUND

Antenatal care (ANC) plays a crucial role in ensuring maternal and child safety and reducing adverse delivery outcomes. This study aimed to analyze the association between the quality of ANC and the occurrence of preterm birth and low birth weight in a sample of the population from 16 regions in 8 provinces in China.

METHODS

Data from all closed cases of pregnant women and newborns reported in the Maternal and Child Health Monitoring System from January 1, 2018, to December 31, 2018, in 16 monitoring regions across 8 provinces in China were collected and included in the analysis, resulting in a total of 49,084 pregnant women and 49,026 newborns.

RESULTS

The mean number of ANC visits was 6.95 ± 3.45. By percentage, 78.79% of the women received ANC examinations at least five times. The percentage of normative ANC examinations and the percentage of qualified ANC examinations was 30.98% and 8.0% respectively. The gestational age(χ2 = 229.305, p<0.001), birth weight (χ2 = 171.990, p<0.001) and the occurrence of neonatal complications (χ2 = 53.112, p<0.001) were all significantly related to the number of ANC visits to mothers. There was a correlation between gestational age (χ2 = 1021.362, p<0.001;χ2 = 194.931, p<0.001) and birth weight (χ2 = 259.009, p<0.001; χ2 = 70.042, p<0.001) with normative ANC and qualified ANC examinations. As the number of ANC examinations increased, the rates of preterm birth and low birth weight decreased. Pregnant women who did not receive normative ANC examinations had a higher risk of preterm birth and neonatal low birth weight compared to those who did; Adjusted Odds Ratio (95%CI) was 23.33(16.97~32.07)and 1.61(1.37~1.90) respectively. Pregnant women who did not receive qualified ANC examinations had a higher risk of preterm birth and neonatal low birth weight compared to those who did; Adjusted Odds Ratio (95%CI) was 15.05(8.45~26.79)and 1.36 (1.02~1.82) respectively.

CONCLUSION

The percentage of women who received normative ANC examination and qualified ANC examination is still low in China, and the quality of antenatal care significantly affects the occurrence of preterm birth and low birth weight in newborns.

Impact of COVID-19 mitigation measures on perinatal outcomes in the Netherlands

OBJECTIVE

Investigate the acute impact of COVID-19 mitigation measures implemented in March 2020 on a comprehensive range of perinatal outcomes.

STUDY DESIGN

National registry-based quasi-experimental study.

METHODS

We obtained data from the Dutch Perinatal Registry (2010-2020) which was linked to multiple population registries containing sociodemographic variables. A difference-in-discontinuity approach was used to examine the impact of COVID-19 mitigation measures on various perinatal outcomes. We investigated preterm birth incidence across onset types, alongside other perinatal outcomes including low birth weight, small-for-gestational-age, NICU admission, low-APGAR-score, perinatal mortality, neonatal death, and stillbirths.

RESULTS

The analysis of the national-level dataset revealed a consistent pattern of reduced preterm births after the enactment of COVID-19 mitigation measures on March 9, 2020 (OR = 0.80, 95% CI 0.68-0.96). A drop in spontaneous preterm births post-implementation was observed (OR = 0.80, 95% CI 0.62-0.98), whereas no change was observed for iatrogenic births. Regarding stillbirths (OR = 0.95, 95% CI 0.46-1.95) our analysis did not find compelling evidence of substantial changes. For the remaining outcomes, no discernible shifts were observed.

CONCLUSIONS

Our findings confirm the reduction in preterm births following COVID-19 mitigation measures in the Netherlands. No discernible changes were observed for other outcomes, including stillbirths. Our results challenge previous concerns of a potential increase in stillbirths contributing to the drop in preterm births, suggesting alternative mechanisms.

Life course epidemiology and public health

Life course epidemiology aims to study the effect of exposures on health outcomes across the life course from a social, behavioural, and biological perspective. In this Review, we describe how life course epidemiology changes the way the causes of chronic diseases are understood, with the example of hypertension, breast cancer, and dementia, and how it guides prevention strategies. Life course epidemiology uses complex methods for the analysis of longitudinal, ideally population-based, observational data and takes advantage of new approaches for causal inference. It informs primordial prevention, the prevention of exposure to risk factors, from an eco-social and life course perspective in which health and disease are conceived as the results of complex interactions between biological endowment, health behaviours, social networks, family influences, and socioeconomic conditions across the life course. More broadly, life course epidemiology guides population-based and high-risk prevention strategies for chronic diseases from the prenatal period to old age, contributing to evidence-based and data-informed public health actions. In this Review, we assess the contribution of life course epidemiology to public health and reflect on current and future challenges for this field and its integration into policy making.