Reductions in Cardiovascular, Cerebrovascular, and Respiratory Mortality following the National Irish Smoking Ban: Interrupted Time-Series Analysis

Abstract

BackgroundPrevious studies have shown decreases in cardiovascular mortality following the implementation of comprehensive smoking bans. It is not known whether cerebrovascular or respiratory mortality decreases post-ban. On March 29, 2004, the Republic of Ireland became the first country in the world to implement a national workplace smoking ban. The aim of this study was to assess the effect of this policy on all-cause and cause-specific, non-trauma mortality.MethodsA time-series epidemiologic assessment was conducted, utilizing Poisson regression to examine weekly age and gender-standardized rates for 215,878 non-trauma deaths in the Irish population, ages ≥35 years. The study period was from January 1, 2000, to December 31, 2007, with a post-ban follow-up of 3.75 years. All models were adjusted for time trend, season, influenza, and smoking prevalence.ResultsFollowing ban implementation, an immediate 13% decrease in all-cause mortality (RR: 0.87; 95% CI: 0.76–0.99), a 26% reduction in ischemic heart disease (IHD) (RR: 0.74; 95% CI: 0.63–0.88), a 32% reduction in stroke (RR: 0.68; 95% CI: 0.54–0.85), and a 38% reduction in chronic obstructive pulmonary disease (COPD) (RR: 0.62; 95% CI: 0.46–0.83) mortality was observed. Post-ban reductions in IHD, stroke, and COPD mortalities were seen in ages ≥65 years, but not in ages 35–64 years. COPD mortality reductions were found only in females (RR: 0.47; 95% CI: 0.32–0.70). Post-ban annual trend reductions were not detected for any smoking-related causes of death. Unadjusted estimates indicate that 3,726 (95% CI: 2,305–4,629) smoking-related deaths were likely prevented post-ban. Mortality decreases were primarily due to reductions in passive smoking.ConclusionsThe national Irish smoking ban was associated with immediate reductions in early mortality. Importantly, post-ban risk differences did not change with a longer follow-up period. This study corroborates previous evidence for cardiovascular causes, and is the first to demonstrate reductions in cerebrovascular and respiratory causes.

Normative misperceptions of tobacco use among university students in seven European countries: Baseline findings of the ‘Social Norms Intervention for the prevention of Polydrug usE’ study

“…There are considerable variations in the strategies (e.g., smoking bans, tobacco taxation, anti-tobacco media campaigns) adopted by individual countries and differences in the degree to which these strategies are enforced (Gallus et al, 2014). In some countries, such as Ireland, public smoking bans were introduced (starting in 2004) and strictly enforced and led to immediate reductions in tobacco-related mortality and morbidity (Stallings-Smith, Zeka, Goodman, Kabir, & Clancy, 2013;Stallings-Smith, Goodman, Kabir, Clancy, & Zeka, 2014). In contrast, in Germany, while federal smoke-free laws to ban smoking in public places were passed in 2007 (Federal non-smokers protection Act , 2007; Law to protect against the dangers of passive smoking, 2007), smoking ban exemptions of the introduced law were subsequently passed at the state level.…”

Longitudinal Associations of Smoke-Free Policies and Incident Cardiovascular Disease

“…DOI: 10.1161/CIRCULATIONAHA.117.032302 August 7, 2018 563 ORIGINAL RESEARCH ARTICLE larger associations, with cardiovascular events ranging from 25% to 39% lower. 18,20,30,45,46 One potential explanation for the relatively larger magnitude of associations seen in our study is that the study population of the CARDIA cohort includes participants who were enrolled in young adulthood and were at maximum 64 years old at the time of their first cardiovascular event. 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.…”

“…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.…”

“…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.…”

Tobacco dependence; the whole story

“…For example, Smoking has been associated with poor nutrition, co-morbidities, impaired immune function and accelerated carcinogenesis and disease progression. 70,71,72,73,74 Second, patients who continue to smoke while they are receiving chemo and radiotherapy are at risk of receiving suboptimal therapy for their cancer 75 and have a higher chance of developing adverse events related to these modalities of treatment. 76,77,78 Third, the development of a second malignant primary tumor and the negative impact of smoking on the life of cancer survivors are other significant risks that cancer patients who continue to smoke must deal with.…”