Article Text
Abstract
Objectives Recent studies suggest that comprehensive smoking regulations to decrease exposure to second-hand smoke reduce the rates of acute myocardial infarction (AMI). The objective of this paper is to analyse if deaths due to AMI in Spain declined after smoking prevention legislation came into force in January 2006.
Design Information was collected on deaths registered by the Instituto Nacional de Estadística for 2004–2007. Age- and sex-specific annual AMI mortality rates with 95% CIs were estimated, as well as age-adjusted annual AMI mortality rates by sex. Annual relative risks of death from AMI were estimated with an age-standardised Poisson regression model.
Results Adjusted AMI mortality rates in 2004 and 2005 are similar, but in 2006 they show a 9% decline for men and a 8.7% decline for women, especially among those over 64 years of age. In 2007 there is a slower rate of decline, which reaches statistical significance for men (−4.8%) but not for women (−4%). The annual relative risk of AMI death decreased in both sexes (p<0.001) from 1 to 0.90 in 2006, and to 0.86 in 2007.
Conclusion The extension of smoke-free regulations in Spain was associated with a reduction in AMI mortality, especially among the elderly. Although other factors may have played a role, this pattern suggests a likely influence of the reduction in population exposure to second-hand smoke on AMI deaths.
- Public health
- preventive medicine
- health policy
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Footnotes
To cite: Villalbí JR, Sánchez E, Benet J, et al. The extension of smoke-free areas and acute myocardial infarction mortality: before and after study. BMJ Open 2011;1:e000067. doi:10.1136/bmjopen-2011-000067
Members of the Barcelona Group for Smoking Regulation Policies Evaluation include Josep Benet, Carmen Cabezas, Antonia Castillo, Montse Cleries, Albert Espelt, Alex Guarga, Rosa Martínez, Manel Nebot, Esteve Saltó, Emília Sánchez, Moisés Sualdea, Ricard Tresserras, Emili Vela and Joan R Villalbí.
Funding This work was supported partially with funds provided by the Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP) to the Agència de Salut Pública de Barcelona for evaluative research in public health.
Competing interests None.
Contributors JRV conceived the study, collected secondary data, carried out the initial statistical analysis, and drafted the manuscript. EmS, EsS and CC wrote sections of the manuscript. All authors reviewed the manuscript and contributed to its final form. Albert Espelt performed the Poisson regression model.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Not applicable.