Hospital admissions for acute myocardial infarction before and after implementation of a comprehensive smoke-free policy in Uruguay

Abstract

Background: Stimulated by the WHO Framework Convention on Tobacco Control, many countries in Latin America adopted comprehensive smoke-free policies. In March 2006, Uruguay became the first Latin American country to adopt 100% smoke-free national legislation, which ended smoking in all indoor public places and workplaces, including restaurants and bars. The objective of this study was to evaluate trends in hospital admissions for cardiovascular disease 2 years before and 2 years after the policy was implemented in Uruguay.

Methods: Reports of hospital admissions for acute myocardial infarction (AMI) (International Classification of Disease-10 I21) from 37 hospitals (79% of all hospital admissions in the country), representing the period 2 years before and 2 years after the adoption of a nationwide smoke-free policy in Uruguay (between 1 March 2004 and 29 February 2008), were reviewed. A time series analysis was undertaken to compare the average monthly number of events of hospital admission for AMI before and after the smoke-free law.

Results: A total of 7949 hospital admissions for AMI were identified during the 4-year study period. Two years after the smoke-free policy was enacted, hospital admissions for AMI fell by 22%. The same pattern and roughly the same magnitude of reduction in AMI admissions were observed for patients seen in public and private hospitals, men, women and people aged 40-65 years and older than 65 years.

Conclusions: The national smoke-free policy implemented in Uruguay in 2006 was associated with a significant reduction in hospital admissions for AMI.

Keywords: Tobacco industry, public opinion polls, environmental tobacco smoke, packaging and labelling, advocacy, smoking-caused disease, prevalence, taxation and price, harm reduction, cessation, economics, environment, advertising and promotion, litigation.

Figure 1

The solid line shows the total number of acute myocardial infarction (AMI) events per month in Uruguay from 1 March 2004 to 29 February 2008. The dashed line is the counterfactual of no law obtained by setting the ‘law’ dummy to zero in the regression equation. The vertical line indicates the date of the smoke-free policy implementation (1 March 2006). This figure is produced in colour in the online journal—please visit the website to view the colour figure.