The Impact of the 2002 Delaware Smoking Ordinance on Heart Attack and Asthma

Abstract

Abstract:In the United States, smoking is the leading cause of death -having a mortality rate of approximately 435,000 people in 2000-accounting for 8.1% of all US deaths recorded that year. Consequently, we analyzed the Delaware Hospital Discharge Database, and identified state and non-state residents discharged with AMI or asthma for the years 1999 to 2004. Statistical data analysis compared the incidence of AMI or asthma for each group before (1999-2002) and after (2003-2004) the amendment. As a result, we found that pre-ordinance and post-ordinance quarterly rates of AMI for Delaware residents were 451 (se = 21) and 430 (se = 21) respectively, representing a 4.7% reduction. Over the same time period, there was negligible change in the incidence of AMI for non-Delaware residents. After adjusting for population growth, the Risk Ratio (RR) for asthma in Delaware residents post-ordinance was 0.95 (95% CI, 0.90 to 0.999), which represented a significant reduction (P = 0.046). By comparison, non-Delaware residents had an increased RR for asthma post-ordinance of 1.62 (95% CI, 1.46 to 1.86; P < 0.0001).The results suggest that Delaware's comprehensive non-smoking ordinance effectively was associated with a statistically significant decrease in the incidence of AMI and asthma in Delaware residents when compared to non-Delaware residents.

Short-term impact of the smokefree legislation in England on emergency hospital admissions for asthma among adults: a population-based study

“…This implies that almost 1900 emergency admissions for asthma were prevented in England during the first year after legislation was introduced and a similar number of emergency admissions for asthma were prevented in the subsequent 2 years. The decrease in emergency admissions for asthma among adults was lower than that observed in other countries 17–19 22. This may be attributable in part to the differences in the specification of the long-term trend between these studies and ours.…”

“…Only a few studies have examined impacts in adults and collectively the findings from these studies are inconclusive. For example, studies in Ireland,19 Kentucky17 and Delaware22 reported statistically significant reductions in hospital asthma admissions after the introduction of smoke-free legislation of 40%, 24% and 5% respectively, while a New Zealand18 study reported a non-statistically significant decline of 16%. Moreover some of these studies have limited statistical power due to small study populations and it is unclear whether underlying long-term trends in asthma admissions were properly controlled for.…”

“…A study in Ireland19 applied a Poisson regression model to admissions data collected for 2 years pre and post legislation, which was adjusted for differences in potential confounding factors (eg, flu and temperature) between the two time periods, but did not adjust for long-term trends which would have captured temporal changes in other risk factors. The study in Delaware also applied a Poisson regression model which adjusted for seasonal effects and population size, but the estimated effect of 5% did not include adjustment for a long-term trend 22. Incorrect assumptions about the shape of the trend or ignoring it completely can result in a biased estimate of the effect of a ban 23…”

Smokefree legislation effects on respiratory and sensory disorders: A systematic review and meta-analysis

“…With respect to the nine studies carried out in the general population[ 34 , 42 , 45 , 46 , 51 , 60 , 61 , 64 , 75 ], six of them (66.7%) were quasi-experimental[ 42 , 45 , 46 , 51 , 60 , 61 ], and, with the exception of one[ 61 ], all were performed in comprehensive SFL locations. In eight studies (88.9%), admission rates for asthma (both hospital and non-hospital admissions) significantly declined with a range of 5.0%[ 60 ] to 31.0% (the latter figure was for Caucasians in Texas[ 45 ]). In addition, a significant annual rate of reduction of -0.35 [95% confidence interval (CI) -0.53 to -0.018] in hospital asthma admissions was obtained in the sole study on partial SFL[ 61 ] when it compared SFL in restaurants versus public areas and workplaces over the ten-year study period.…”

Association between Florida's smoke-free policy and acute myocardial infarction by race: A time series analysis, 2000–2013

“…The extent to which these policies have a pro- or anti-equity impact is important to know, given the widening racial gap in AMI. Studies of the impact of smoke-free policy on AMI in the U.S. often do not address this question, or are unable to due to small numbers within racial/ethnic subgroups of the study population (Bartecchi et al, 2006; Bruintjes et al, 2011; Gupta et al, 2011; Hahn et al, 2011; Hurt et al, 2012; Moraros et al, 2010). Of the available literature, Dinno & Glantz (2009) found no interaction between clean indoor air laws and race/ethnicity for either current smoking status or daily cigarette consumption, thus concluding that there was an equal affect across groups.…”