Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Jun 8:340:c2161.
doi: 10.1136/bmj.c2161.

Short term impact of smoke-free legislation in England: retrospective analysis of hospital admissions for myocardial infarction

Michelle Sims  1 , Roy Maxwell, Linda Bauld, Anna Gilmore
Affiliations

Short term impact of smoke-free legislation in England: retrospective analysis of hospital admissions for myocardial infarction

Michelle Sims et al. BMJ. .

Abstract

Objective: To measure the short term impact on hospital admissions for myocardial infarction of the introduction of smoke-free legislation in England on 1 July 2007.

Design: An interrupted time series design with routinely collected hospital episode statistics data. Analysis of admissions from July 2002 to September 2008 (providing five years' data from before the legislation and 15 months' data from after) using segmented Poisson regression.

Setting: England. Population All patients aged 18 or older living in England with an emergency admission coded with a primary diagnosis of myocardial infarction.

Main outcome measures: Weekly number of completed hospital admissions.

Results: After adjustment for secular and seasonal trends and variation in population size, there was a small but significant reduction in the number of emergency admissions for myocardial infarction after the implementation of smoke-free legislation (-2.4%, 95% confidence interval -4.06% to -0.66%, P=0.007). This equates to 1200 fewer emergency admissions for myocardial infarction (1600 including readmissions) in the first year after legislation. The reduction in admissions was significant in men (3.1%, P=0.001) and women (3.8%, P=0.007) aged 60 and over, and men (3.5%, P<0.01) but not women (2.5% P=0.38) aged under 60.

Conclusion: This study adds to a growing body of evidence that smoke-free legislation leads to reductions in myocardial infarctions. It builds on previous work by showing that such declines are observed even when underlying reductions in admissions and potential confounders are controlled for. The considerably smaller decline in admissions observed in England compared with many other jurisdictions probably reflects aspects of the study design and the relatively low levels of exposure to secondhand smoke in England before the legislation.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that all authors had: (1) Financial support for the submitted work as detailed above; (2) No financial relationships with commercial entities that might have an interest in the submitted work; (3) No spouses, partners, or children with relationships with commercial entities that might have an interest in the submitted work; (4) No non-financial interests that may be relevant to the submitted work.

Figures

None
Fig 1 Trends in weekly number of emergency admissions for myocardial infarction (average daily count) from January 2000 to September 2008 by age and sex. Note different ranges on y axis
None
Fig 2 Trends in overall weekly number of emergency admissions for myocardial infarction (average daily count) from January 2000 to September 2008. Note, weekly numbers of admissions are sum of four graphs in figure 1
None
Fig 3 Trends in overall weekly number of emergency admissions for myocardial infarction (average daily count) averaged across years
See this image and copyright information in PMC

References

    1. Glantz S, Parmley W. Passive smoking and heart disease: epidemiology, physiology, and biochemistry. Circulation 1991;83:1-12. - PubMed
    1. Glantz SA, Parmley WW. Passive smoking and heart disease: mechanisms and risk. JAMA 1995;273:1047-53. - PubMed
    1. He J, Vupputuri S, Allen K, Prerost MR, Hughes J, Whelton PK. Passive smoking and the risk of coronary heart disease—a meta-analysis of epidemiologic studies. N Engl J Med 1999;340:920-6. - PubMed
    1. Law MR, Morris JK, Wald NJ. Environmental tobacco smoke exposure and ischaemic heart disease: an evaluation of the evidence. BMJ 1997;315:973-80. - PMC - PubMed
    1. Thun M, Henley J, Apicella L. Epidemiologic studies of fatal and nonfatal cardiovascular disease and ETS exposure from spousal smoking. Environ Health Perspect 1999;107:841-6. - PMC - PubMed

Publication types

MeSH terms

Substances