RT Journal Article
SR Electronic
T1 Assessing the effects of the Spanish partial smoking ban on cardiovascular and respiratory diseases: methodological issues
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e008892
DO 10.1136/bmjopen-2015-008892
VO 5
IS 12
A1 Iñaki Galán
A1 Lorena Simón
A1 Víctor Flores
A1 Cristina Ortiz
A1 Rafael Fernández-Cuenca
A1 Cristina Linares
A1 Elena Boldo
A1 María José Medrano
A1 Roberto Pastor-Barriuso
YR 2015
UL http://bmjopen.bmj.com/content/5/12/e008892.abstract
AB Objective Recent research has assessed the impact of tobacco laws on cardiovascular and respiratory morbidity. In this study, we also examined whether the association between the implementation of the 2005 Spanish smoking ban and hospital admissions for cardiovascular and respiratory diseases varies according to the adjustment for potential confounders.Design Ecological time series analysis.Setting Residents of Madrid and Barcelona cities (Spain).Outcome Data on daily emergency room admissions for acute myocardial infarction, cerebrovascular disease, chronic obstructive pulmonary disease (COPD), and asthma derived from the 2003–2006 Spanish hospital admissions registry.Methods Changes in admission rates between 2006 and the 2003–2005 period were estimated using additive Poisson models allowing for overdispersion adjusted for secular trend in admission, seasonality, day of the week, temperature, number of flu and acute respiratory infection cases, pollution levels, tobacco consumption prevalence and, for asthma cases, pollen count.Results In Madrid, fully adjusted models failed to detect significant changes in hospital admission rates for any disease during the study period. In Barcelona, however, hospital admissions decreased by 10.2% (95% CI 3.8% to 16.1%) for cerebrovascular diseases and by 16.0% (95% CI 7.0% to 24.1%) for COPD. Substantial changes in effect estimates were observed on adjustment for linear or quadratic trend. Effect estimates for asthma-related admissions varied substantially when adjusting for pollen count in Madrid, and for seasonality and tobacco consumption in Barcelona.Conclusions Our results confirm that the potential impact of a smoking ban must be adjusted for the underlying secular trend. In asthma-related admissions, pollen count, seasonality and tobacco consumption must be specified in the model. The substantial variability in effects detected between the two cities of Madrid and Barcelona lends strong support for a nationwide study to assess the overall effect of a smoking ban in Spain and identify the causes of the observed heterogeneity.