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MI admissions in England fell after smoking ban

BMJ 2010; 340: c2161

Myocardial infarction (MI) admissions in England, UK, fell by 1200 in the year following the introduction of smoke-free laws, researchers report.


In the British Medical Journal, Anna Gilmore, from the University of Bath, UK, and colleagues explain: "The risk for coronary heart disease rapidly increases even at low levels of tobacco smoke exposure. Measures such as smoke-free legislation are likely to reduce the incidence of acute coronary events."

In the study, Gilmore et al compared the number of patients aged 18 years or older admitted to National Health Service (NHS) care in England with a first presentation of MI during the 5 years before the smoke-free legislation was introduced in July 2007 with that in the 1.25 years after.

After adjusting for trends in population size, seasonal variation, and pre-existing admissions decline, a significant reduction of 2.4% in admissions for MI was noted after the smoking ban was implemented (p=0.007).

The reduction was significant among men 60 years and older (3.1%) and younger than 60 years (3.5%), but in women the reduction was significant only in those aged 60 years and over (3.8%) and not in younger women (2.5%).

Studies in other countries have shown a similar effect following smoke-free law implementation, although in these studies, MI admission numbers fell by a greater proportion. In the USA and Scotland, reductions of 27–40% and 17%, respectively, were reported.

Gilmore and colleagues comment that the smaller reduction noted in England may be due to the study design, which controlled for more confounding factors than did these similar studies, as well as the adoption of smoking bans in public places in advance of the legislation.

"The decline in smoke exposure and the resulting health benefits of smoke-free legislation that occurred immediately after the implementation of legislation are likely to have been less marked than those observed elsewhere," they explain.

The researchers conclude that for conditions with high rates such as MI, "even the relatively small reduction seen in England has important public health benefits."


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