Smoke-free legislation and hospitalizations for acute coronary syndrome.
BACKGROUND
Previous studies have suggested a reduction in the total number of hospital admissions for acute coronary syndrome after the enactment of legislation banning smoking in public places. However, it is unknown whether the reduction in admissions involved nonsmokers, smokers, or both.


METHODS
Since the end of March 2006, smoking has been prohibited by law in all enclosed public places throughout Scotland. We collected information prospectively on smoking status and exposure to secondhand smoke based on questionnaires and biochemical findings from all patients admitted with acute coronary syndrome to nine Scottish hospitals during the 10-month period preceding the passage of the legislation and during the same period the next year. These hospitals accounted for 64% of admissions for acute coronary syndrome in Scotland, which has a population of 5.1 million.


RESULTS
Overall, the number of admissions for acute coronary syndrome decreased from 3235 to 2684--a 17% reduction (95% confidence interval, 16 to 18)--as compared with a 4% reduction in England (which has no such legislation) during the same period and a mean annual decrease of 3% (maximum decrease, 9%) in Scotland during the decade preceding the study. The reduction in the number of admissions was not due to an increase in the number of deaths of patients with acute coronary syndrome who were not admitted to the hospital; this latter number decreased by 6%. There was a 14% reduction in the number of admissions for acute coronary syndrome among smokers, a 19% reduction among former smokers, and a 21% reduction among persons who had never smoked. Persons who had never smoked reported a decrease in the weekly duration of exposure to secondhand smoke (P<0.001 by the chi-square test for trend) that was confirmed by a decrease in their geometric mean concentration of serum cotinine from 0.68 to 0.56 ng per milliliter (P<0.001 by the t-test).


CONCLUSIONS
The number of admissions for acute coronary syndrome decreased after the implementation of smoke-free legislation. A total of 67% of the decrease involved nonsmokers. However, fewer admissions among smokers also contributed to the overall reduction.
Pell
Jill P
JP
University of Glasgow, United Kingdom. j.pell@clinmed.gla.ac.uk
Haw
Sally
S
Cobbe
Stuart
S
Newby
David E
DE
Pell
Alastair C H
AC
Fischbacher
Colin
C
McConnachie
Alex
A
Pringle
Stuart
S
Murdoch
David
D
Dunn
Frank
F
Oldroyd
Keith
K
Macintyre
Paul
P
O'Rourke
Brian
B
Borland
William
W
D054058:Acute Coronary Syndrome / Q000097:blood / Q000453:epidemiology*; D000367:Age Factors; D000368:Aged; D003367:Cotinine / Q000097:blood; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012606:Scotland / Q000453:epidemiology; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology / Q000331:legislation & jurisprudence*; D014028:Tobacco Smoke Pollution / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data
D014028:Tobacco Smoke Pollution; D003367:Cotinine