Impact of stepwise introduction of smoke-free legislation on population rates of acute myocardial infarction deaths in Flanders, Belgium

Cox, Bianca; Vangronsveld, Jaco; Nawrot, Tim S.

doi:10.1136/heartjnl-2014-305613

Cited by 36 publications

(36 citation statements)

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“…Several prior ecological studies in the United States and European countries reported stronger relative risks of smoke-free policies with lower rates of hospital admissions among younger people. [26][27][28][29]34,35 For example, Cox et al 29 found smoke-free policy implementation in Belgium to be associated with a 34% lower rate of deaths from acute myocardial infarction among women under 60 years compared to only 7.9% among women 60 years or older. Similarly, Barone-Adesi et al 28 found smoke-free policy implementation in northern Italy to be associated with a 25% lower rate of hospital admission for acute myocardial infarction among women <60 years of age and no association among those >60 years of age.…”

Section: Original Research Articlementioning

confidence: 99%

“…These findings complement an existing body of literature that has generally indicated that smoke-free policy implementation is associated with lower rates of hospital admissions or mortality for cardiovascular disease. 16,17,[19][20][21][22][27][28][29][30][31][32][33][34][35] Prior studies have typically been ecological in nature [14][15][16][17][18][19][20][22][23][24][25][26][27][28][29][30][31][34][35][36] and have not had access to detailed individual-level information on sociodemographic characteristics and cardiovascular disease risk factors. Our findings that patterns were largely similar after controlling for a large number of potential confounders suggest that differences in cardiovascular disease risk among those in areas with and without smoke-free policies are not explained by differences in individual sociodemographics or traditional cardiovascular disease risk factors.…”

Section: Original Research Articlementioning

confidence: 99%

“…Results generally indicated that policies were associated with lower rates of cardiovascular admissions, although a few studies found no association, 24,25 found results to be sensitive to linearity assumptions, 14 or found associations in only certain settings 18 or subgroups of the population. 26 In addition, several prior studies have shown stronger associations of smoke-free policies with lower rates of cardiovascular disease admissions among younger age groups, [26][27][28][29] suggesting that these policies may be an effective means of reducing premature cardiovascular disease.…”

mentioning

confidence: 99%

“…Prior studies have used primarily ecological designs, [14][15][16][17][18][19][20][22][23][24][25][26][27][28][29][30][31][34][35][36] and have lacked access to detailed individual-level data on sociodemographic characteristics and cardiovascular disease risk factors. Interpretation of results from ecological studies is limited by the potential for unmeasured confounding by individuallevel characteristics, a drawback that could be reduced by using data from ongoing cohort studies.…”

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confidence: 99%

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Longitudinal Associations of Smoke-Free Policies and Incident Cardiovascular Disease

et al. 2018

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Editorial, see p 567BACKGROUND: Smoke-free legislation has been associated with lower rates of cardiovascular disease hospital admissions in ecological studies. However, prior studies lacked detailed information on individuallevel factors (eg, sociodemographic and clinical characteristics) that could potentially confound associations. Our objective was to estimate associations of smoke-free policies with incident cardiovascular disease in a longitudinal cohort after controlling for sociodemographics, cardiovascular disease risk factors, and policy covariates. METHODS:Longitudinal data from 3783 black and white adults in the CARDIA study (Coronary Artery Risk Development in Young Adults; 1995 were linked to state, county, and local 100% smoke-free policies in bars, restaurants, and nonhospitality workplaces by Census tract. Extended Cox regression estimated hazard ratios (HRs) of incident cardiovascular disease associated with time-dependent smoke-free policy exposures. Models were adjusted for sociodemographic characteristics, cardiovascular disease risk factors, state cigarette tax, participantreported presence of a smoking ban at their workplace, field center, and metropolitan statistical area poverty. RESULTS:During a median follow-up of 20 years (68 332 total personyears), 172 participants had an incident cardiovascular disease event (2.5 per 1000 person-years). Over the follow-up period, 80% of participants lived in areas with smoke-free policies in restaurants, 67% in bars, and 65% in nonhospitality workplaces. In fully adjusted models, participants living in an area with a restaurant, bar, or workplace smoke-free policy had a lower risk of incident cardiovascular disease compared with those in areas without smoke-free policies (HR, 0.75, 95% confidence interval, HR, 0.76, 95% confidence interval, HR, 0.54, 95% confidence interval, respectively; HR, 0.58, 95% confidence interval, for living in an area with all 3 types of policies compared with none). The estimated preventive fraction was 25% for restaurant policies, 24% for bar policies, and 46% for workplace policies. CONCLUSIONS:Consistent with prior ecological studies, these individualbased data add to the evidence that 100% smoke-free policies are associated with lower risk of cardiovascular disease among middle-aged adults.

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Section: Original Research Articlementioning

confidence: 99%

Section: Original Research Articlementioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Longitudinal Associations of Smoke-Free Policies and Incident Cardiovascular Disease

et al. 2018

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“…Analisando estudos prévios realizados para a avaliação da influência das leis anti fumo na incidência de internações e mortalidade por infarto agudo do miocárdio, nota-se uma redução nas taxas de internação na maior parte dos Discussão estudos 28,34,36,42,60,71,72 e uma redução na mortalidade em uma parte dos estudos. [73][74][75][76] Esta redução é verificada de maneira mais significativa no primeiro ano após o início da vigência das leis, sendo que a maior parte dos estudos avaliou períodos de 12 a 24 meses após o início da vigência de suas leis. Além disso, observa-se que estudos realizados em cidades ou localidades menores, em que é possível realizar um controle da população e dos locais de atendimeto médico, o efeito da lei foi mais exuberante, 34,42 ao passo que em localidades maiores ou países os efeitos da lei são pequenos ou moderados.…”

Section: Modelo Arimax Internação Por "Infarto"unclassified

Internação e mortalidade por doença cardiovascular e cerebrovascular no período anterior e posterior à lei antitabaco na cidade de São Paulo

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Infarto", metodologia ARIMAX ANEXO B-Modelo estimado para taxa de internações por "AVC", metodologia ARIMAX ANEXO C-Modelo estimado para taxa de mortalidade por "Infarto", metodologia ARIMAX ANEXO D-Modelo estimado para taxa de mortalidade por "AVC", metodologia ARIMAX ANEXO E-Modelo estimado para taxa de internações por "Infarto", metodologia ITSA-ARIMAX ANEXO F-Modelo estimado para taxa de internações por "AVC", metodologia ITSA-ARIMAX ANEXO G-Modelo estimado para taxa de mortalidade por "Infarto", metodologia ITSA-ARIMAX ANEXO H-Modelo estimado para taxa de mortalidade por "AVC", metodologia ITSA-ARIMAX

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Evaluation of Population-Level Tobacco Control Interventions and Health Outcomes

et al. 2023

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ImportanceSmoking causes considerable noncommunicable diseases, perinatal morbidity, and mortality.ObjectiveTo investigate the associations of population-level tobacco-control policies with health outcomes.Data SourcesPubMed, EMBASE, Web of Science, Cumulated Index to Nursing and Allied Health Literature, and EconLit were searched from inception to March 2021 (updated on 1 March 2022). References were manually searched.Study SelectionStudies reporting on associations of population-level tobacco control policies with health-related outcomes were included. Data were analyzed from May to July 2022.Data Extraction and SynthesisData were extracted by 1 investigator and cross-checked by a second investigator. Analyses were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline.Main Outcomes and MeasuresThe primary outcomes were respiratory system disease (RSD), cardiovascular disease (CVD), cancer, mortality, hospitalization, and health care utilization. The secondary outcomes were adverse birth outcomes, such as low birth weight and preterm birth. Random-effects meta-analysis was used to estimate pooled odds ratios (ORs) and 95% CIs.ResultsOf 4952 records identified, 144 population-level studies were included in the final analysis; 126 studies (87.5%) were of high or moderate quality. The most frequently reported policies were smoke-free legislation (126 studies), followed by tax or price increases (14 studies), multicomponent tobacco control programs (12 studies), and a minimum cigarette purchase age law (1 study). Smoke-free legislation was associated with decreased risk of all CVD events (OR, 0.90; 95% CI, 0.86-0.94), RSD events (OR, 0.83; 95% CI, 0.72-0.96), hospitalization due to CVD or RSD (OR, 0.91; 95% CI, 0.87-0.95), and adverse birth outcomes (OR, 0.94; 95% CI, 0.92-0.96). These associations persisted in all sensitivity and subgroup analyses, except for the country income category, for which a significant reduction was only observed in high-income countries. In meta-analysis, there was no clear association of tax or price increases with adverse health outcomes. However, for the narrative synthesis, all 8 studies reported statistically significant associations between tax increases and decreases in adverse health events.Conclusions and RelevanceIn this systematic review and meta-analysis, smoke-free legislation was associated with significant reductions in morbidity and mortality related to CVD, RSD, and perinatal outcomes. These findings support the need to accelerate the implementation of smoke-free laws to protect populations against smoking-related harm.

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Impact of stepwise introduction of smoke-free legislation on population rates of acute myocardial infarction deaths in Flanders, Belgium

Abstract: Smoking ban interventions are associated with reductions in the population rate of myocardial mortality, with public health gains even before and during the middle-aged period of life.

Cited by 36 publications

References 36 publications

Longitudinal Associations of Smoke-Free Policies and Incident Cardiovascular Disease

Longitudinal Associations of Smoke-Free Policies and Incident Cardiovascular Disease

Internação e mortalidade por doença cardiovascular e cerebrovascular no período anterior e posterior à lei antitabaco na cidade de São Paulo

Evaluation of Population-Level Tobacco Control Interventions and Health Outcomes

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