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NAQC Newsroom: Tobacco Control

Nationwide Smoking Ban Would Cut MI Rates, Costs

Friday, May 21, 2010  
The following article appeared in the May 20, 2010 issue of MedPage Today,

Extending bans on smoking in public places nationwide would snuff out more than $92 million in heart attack-related direct costs alone in a single year, researchers said.

Comprehensive legislation barring smoking in public and private offices, restaurants, and bars -- even those with ventilated smoking areas -- would result in 18,596 fewer acute myocardial infarction (MI) hospitalizations in the year following implementation, according to an analysis by Mouaz H. Al-Mallah, MD, MSc, of Henry Ford Hospital in Detroit, and colleagues.

Even further benefits might be seen in other disease states, they reported at the American Heart Association's Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke conference.

Smoking's link to acute MI risk is well established, the researchers noted.

An Institute of Medicine report, endorsed by the AHA as well, suggested clear health benefits from smoking bans in reducing heart disease.

A CDC report also supported a long-term benefit, with a dramatic 41% drop in MI hospitalizations maintained over three years after a comprehensive smoking ban went into effect in one city.

But while indoor smoking bans are growing in popularity, only 37 states had smoking bans in restaurants and bars and other public areas as of 2007, according to Al-Mallah's group.

Getting all states on board would be expected to have a substantial public health impact, but it hasn't been quantified, they said.

The investigators contacted the department of health of every state without comprehensive smoking ban legislation to determine the total number of acute MI discharges, and the lengths of stay and charges in dollars for these hospitalizations in 2007.

In that year, the 14 states that did not have comprehensive smoking bans in place reported a total of 169,043 acute MI hospitalizations.

The researchers extrapolated results from a previously published meta-analysis showing an 11% pooled relative risk reduction in acute MI with smoking bans to come up with the 18,596-acute MI reduction expected in the year after a nationwide ban.

The IOM committee that issued the earlier report on indoor smoking bans said the link between heart disease and secondhand smoke exposure is certain to be causal, but cautioned about lack of adequate adjustment for lifestyle and other factors that have gone into the studies from which the meta-analyses draw.

Other studies have cautioned that these pre- versus post-ban analyses cannot distinguish the heart attack rate impact of smokers who quit from reductions in secondhand smoke exposure.

The researchers reported no conflicts of interest.

Primary source: AHA Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke conference

Source reference:
Al-Mallah MH, et al "The impact of a potential nationwide comprehensive smoking ban on acute myocardial infarction hospitalizations" QCOR 2010; Abstract P84.

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