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Smoking and tobacco
Research
The extension of smoke-free areas and acute myocardial infarction mortality: before and after study
  1. Joan R Villalbí1,2,
  2. Emília Sánchez2,3,
  3. Josep Benet4,
  4. Carmen Cabezas5,
  5. Antonia Castillo4,
  6. Alex Guarga4,
  7. Esteve Saltó5,
  8. Ricard Tresserras6,
  9. for the Barcelona Group for Smoking Regulation Policies Evaluation
  1. 1Agència de Salut Pública de Barcelona, Barcelona, Spain
  2. 2CIBERESP, Spain
  3. 3Blanquerna School of Health Science, Universitat Ramon Llull, Barcelona, Spain
  4. 4Regió Sanitària de Barcelona, Servei Català de la Salut, Barcelona, Spain
  5. 5Direcció General de Salut Pública, Departament de Salut, Barcelona, Spain
  6. 6Direcció General de Planificació i Avaluació, Departament de Salut, Barcelona, Spain
  1. Correspondence to Joan R Villalbí; jrvillal{at}aspb.cat

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

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

https://doi.org/10.1136/bmjopen-2011-000067

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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.