Impact of a partial smoke-free legislation on myocardial infarction incidence, mortality and case-fatality in a population-based registry: the REGICOR Study.
OBJECTIVE
Coronary heart disease (CHD) is the leading cause of death, and smoking its strongest modifiable risk factor. Our aim was to determine the impact of the Spanish 2006 partial smoke-free legislation on acute myocardial infarction (AMI) incidence, hospitalization and mortality rates, and 28-day case-fatality in Girona, Spain.


METHODS
Using a population-based registry (the REGICOR Study), we compared population incidence, hospitalization, and mortality rates, and 28-day case-fatality in the pre- and post-ban periods (2002-2005 and 2006-2008, respectively) by binomial regression analysis adjusted for confounding factors. We also analyzed the ban's impact on the outcomes of interest using the AMI definitions of the American Heart Association (AHA)/European Society of Cardiology (ESC) and the World Health Organization (WHO)-Monitoring trends and determinants in cardiovascular diseases (MONICA).


RESULTS
In the post-ban period, AMI incidence and mortality rates significantly decreased (relative risk [RR] = 0.89; 95% confidence interval [CI] = 0.81-0.97 and RR = 0.82; 95% CI = 0.71-0.94, respectively). Incidence and mortality rates decreased in both sexes, especially in women, and in people aged 65-74 years. Former and non-smokers (passive smokers) showed diminished incidence rates. Implementation of the ban was not associated with AMI case-fatality. Models tended to be more significant with the WHO-MONICA than with the AHA/ESC definition.


CONCLUSIONS
The 2006 Spanish partial smoke-free legislation was associated with a decrease in population AMI incidence and mortality, particularly in women, in people aged 65-74 years, and in passive smokers. These results clarify the association between AMI mortality and the enactment of a partial smoke-free legislation and reinforce the effectiveness of smoking regulations in preventing CHD.
Department of Research in Inflammatory and Cardiovascular Disorders (RICAD), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Fernando
F
Agüero
Irene R
IR
Dégano
Isaac
I
Subirana
Maria
M
Grau
Alberto
A
Zamora
Joan
J
Sala
Rafel
R
Ramos
Ricard
R
Treserras
Jaume
J
Marrugat
Roberto
R
Elosua
D000208:Acute Disease; D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000209:etiology / Q000401:mortality*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality*; D012042:Registries; D012044:Regression Analysis; D012307:Risk Factors; D012906:Smoke / Q000009:adverse effects*; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D014026:Nicotiana / Q000009:adverse effects*; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*
D012906:Smoke; D014028:Tobacco Smoke Pollution