Effect of smoke-free legislation on the incidence of sudden circulatory arrest in the Netherlands.
OBJECTIVE
To investigate whether smoke-free legislation in the Netherlands led to a decreased incidence of out-of-hospital sudden circulatory arrest (SCA). Smoke-free legislation was implemented in two phases: a workplace ban in 2004 and an extension of this ban to the hospitality sector on 1 July 2008.


METHODS
Weekly incidence data on SCA were obtained from the ambulance registry of South Limburg, the Netherlands. Three time periods were distinguished: the pre-ban period (1 January 2002-1 January 2004), the first post-ban period (1 January 2004-1 July 2008) and the second post-ban period (1 July 2008-1 May 2010). Trends in absolute SCA incidence were analysed using Poisson regression, adjusted for population size, ambient temperature, air pollution and influenza rates.


RESULTS
A total of 2305 SCA cases were observed (mean weekly incidence 5.3±2.3 SD). The adjusted Poisson regression model showed a small but significant increase in SCA incidence during the pre-ban period (+0.20% cases per week, p=0.044). This trend changed significantly after implementation of the first ban (with -0.24% cases per week, p=0.043), translating into a 6.8% (22 cases) reduction in the number of SCA cases after 1 year of smoke-free legislation. No further decrease was seen after the second smoking ban.


CONCLUSIONS
After introduction of a nationwide workplace smoking ban in 2004, a significant decrease in the incidence of out-of-hospital SCA was seen in South Limburg. Poor enforcement of the 2008 hospitality sector ban may account for the fact that no further decrease in the incidence of SCA was seen at this time.
Department of Epidemiology, Maastricht University, Maastricht, The Netherlands. dianne.dekorte@maastrichtuniversity.nl
Dianne
D
de Korte-de Boer
Daniel
D
Kotz
Wolfgang
W
Viechtbauer
Emiel
E
van Haren
Devina
D
Grommen
Michelle
M
de Munter
Harry
H
Coenen
Anton P M
AP
Gorgels
Onno C P
OC
van Schayck
D000328:Adult; D000368:Aged; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012042:Registries; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology* / Q000331:legislation & jurisprudence; D016540:Smoking Cessation / Q000331:legislation & jurisprudence*; D015996:Survival Rate / Q000639:trends; D014028:Tobacco Smoke Pollution / Q000009:adverse effects / Q000331:legislation & jurisprudence*; D055815:Young Adult
D014028:Tobacco Smoke Pollution