Impact of a Comprehensive Tobacco Control Package on Trends in Hospital Admissions for Depression in Beijing, China: Interrupted Time Series Study

The burden of depression in China is heavy, with inadequate treatment and prevention. Tobacco exposure is widely recognized as a risk factor for depression, but the impact of tobacco control policy interventions on depression has not been evaluated. In 2015, a comprehensive tobacco control package was implemented in Beijing, which was considered the strictest smoking-free ban in China to date, and achieved remarkable tobacco control effects. The objective is to evaluate the impact of the tobacco control policy package on hospital admissions for depression in a global city. An interrupted time series study was conducted to collect hospital admission information of 17.7 million residents covered by the Beijing Medical Claim Data for Employees from January 2013 to June 2017. Segmented Poisson regression models were used to estimate the average percentage change in admission rates and reductions in hospital admissions for depression. A total of 5,028,228 hospital admissions for depression were identified with a crude rate of 633.1 per 10,000 participants during the observational period. After the implementation of the policy, the hospital admission rate for depression did not decrease immediately (0.2%, 95% CI: −0.2 to 0.6%), but its secular trend decreased significantly, with an annual change of −13.8% (95% CI: −14.9 to −12.7%). The annual secular change was substantially smaller among participants aged 65 years or older than among those younger than 65 years of age (−3.1% vs. −17.2%). During the 25-month post-policy period, a total of 267,227 admissions for depression were averted, with an absolute reduction of 9.02% compared with no intervention. The proportion of reduction due to the policy intervention was slight among participants aged ≥65 years, with only 7.25%. After the implementation of Beijing’s 2015 comprehensive tobacco control policy package, hospital admissions for depression decreased significantly, especially in the young people aged less than 65 years. The results support the public health benefits of WHO-recommended tobacco control measures on mental diseases.