Association of anti-smoking legislation with rates of hospital admission for cardiovascular and respiratory conditions

Abstract

Background: Few studies have examined the impact of anti-smoking legislation on respiratory or cardiovascular conditions other than acute myocardial infarction. We studied rates of hospital admission attributable to three cardiovascular conditions (acute myocardial infarction, angina, and stroke) and three respiratory conditions (asthma, chronic obstructive pulmonary disease, and pneumonia or bronchitis) after the implementation of smoking bans.

Methods: We calculated crude rates of admission to hospital in Toronto, Ontario, from January 1996 (three years before the first phase of a smoking ban was implemented) to March 2006 (two years after the last phase was implemented. We used an autoregressive integrated moving-average (ARIMA) model to test for a relation between smoking bans and admission rates. We compared our results with similar data from two Ontario municipalities that did not have smoking bans and with conditions (acute cholecystitis, bowel obstruction and appendicitis) that are not known to be related to second-hand smoke.

Results: Crude rates of admission to hospital because of cardiovascular conditions decreased by 39% (95% CI 38%-40%) and admissions because of respiratory conditions decreased by 33% (95% CI 32%-34%) during the ban period affecting restaurant settings. No consistent reductions in these rates were evident after smoking bans affecting other settings. No significant reductions were observed in control cities or for control conditions.

Interpretation: Our results serve to expand the list of health outcomes that may be ameliorated by smoking bans. Further research is needed to establish the types of settings in which smoking bans are most effective. Our results lend legitimacy to efforts to further reduce public exposure to tobacco smoke.

Figure 1

(A) Crude annual rates of admission to hospital attributable to cardiovascular and respiratory conditions and to control conditions in Toronto from 1996 to 2006. (B) Crude annual rates of admission to hospital for control conditions in Toronto and in control cities of Thunder Bay and Durham Region from 1996 to 2006.

Figure 2

Time-series analysis for angina during the three phases of the ban on smoking in Toronto. (A) First phase. (B) Second phase. (C) Third phase.