PT  - JOURNAL ARTICLE
AU  - Andrew Liu
AU  - Maria Guzman Castillo
AU  - Simon Capewell
AU  - John Lucy
AU  - Martin O'Flaherty
TI  - Reduction in myocardial infarction admissions in Liverpool after the smoking ban: potential socioeconomic implications for policymaking
AID  - 10.1136/bmjopen-2013-003307
DP  - 2013 Nov 01
TA  - BMJ Open
PG  - e003307
VI  - 3
IP  - 11
4099  - http://bmjopen.bmj.com/content/3/11/e003307.short
4100  - http://bmjopen.bmj.com/content/3/11/e003307.full
SO  - BMJ Open2013 Nov 01; 3
AB  - Objectives To analyse the trends and trend changes in myocardial infraction (MI) and coronary heart disease (CHD) admissions, to investigate the effects of the 2007 smoke-free legislation on these trends, and to consider the policy implications of any findings. Design setting Liverpool (city), UK. Participants Hospital episode statistics data on all 56 995 admissions for CHD in Liverpool between 2004 and 2012 (International Classification of Diseases codes I20–I25 coded as an admission diagnosis within the defined dates). Primary and secondary outcome measures Trend gradient and change points (by trend regressions analysis) in age-standardised MI admissions in Liverpool between 2004 and 2012; by sex and by socioeconomic status. Secondary analysis on CHD admissions. Results A significant and sustained reduction was seen in MI admissions in Liverpool beginning within 1 year of the smoking ban. Comparing 2005/2006 and 2010/2011, the age-adjusted rates for MI admissions fell by 42% (39–45%) (41.6% in men and by 42.6% in women). Trend analysis shows that this is significantly greater than the background trend of decreasing admissions. These reductions appeared consistent across all socioeconomic groups. Interestingly, admission rates for total CHD (including mild to severe angina) increased by 10% (8–12%). Conclusions A dramatic reduction in MI admissions in Liverpool has been observed coinciding with the smoking ban in 2007. Furthermore, the benefits were apparent across the socioeconomic spectrum. Health inequalities were not affected and may even have been reduced. The rapid effects observed with this top-down, environmental policy may further increase its value to policymakers.