title: Changes in hospitalization rates for acute coronary syndrome after a two-phase comprehensive smoking ban.
abstract: OBJECTIVE
  The impact of a comprehensive stepwise smoking ban (2007 and 2008) was assessed by analysing the hospitalization rate for acute coronary syndrome (ACS) in France, between 2003 and 2009.
  
  
  RESULTS
  Between 2003 and 2009, 867,164 hospitalizations for ACS were observed among about 23 million administrative reports. The age-and gender-standardized hospitalization rates were calculated and their variation before and after the smoking ban implementation was investigated by Poisson regression that included the ACS seasonal variations and the historical trend. The hospitalization rate decreased by 12.8% (from 269 to 235/100,000) with a significant historical trend reduction (p < 0.10(-3)) in all groups, but in young women. After adjusting for linear trend, reductions linked to the ban remained not significant in all groups: relative risk (RR) from 0.96 (95% CI 0.91-1.01) in men older than 55 years to 0.99 (95% CI 0.93-1.04) in men aged 55 years or less after the first phase, and from 0.96 (95% CI 0.89-1.04) in men older than 55 years to 1.03 (95% CI 0.94-1.12) in women older than 65 years after the second phase of the ban.
  
  
  CONCLUSIONS
  This study did not demonstrate a significant effect of a two-phases smoking ban on ACS hospitalization rate. A steadily decrease of this rate over the 7-year period, the past preventive measures in France leading to low levels of passive smoking, and the significant increase in active smoking during the studied period may explain this result. Our study highlights the difficulty of proving an effect of smoking bans in a country with an already low ACS incidence.
authors.affiliation: Department of Epidemiology, Biostatistics and Medical Information, University Hospital, Montpellier, France f-seguret@chu-montpellier.fr.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Séguret
authors.affiliation: Department of Epidemiology, Biostatistics and Medical Information, University Hospital, Montpellier, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Ferreira
authors.affiliation: Department of Vascular Medicine, University Hospital, Toulouse, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Cambou
authors.affiliation: INSERM, U1061, Montpellier, France University Montpellier I, Montpellier, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Carrière
authors.affiliation: University Paris VI CHU Pitié-Salpêtrière, Paris, France APHP, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Thomas
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D005602:France / Q000453:epidemiology; D033161:Government Regulation; D006291:Health Policy / Q000331:legislation & jurisprudence / Q000639:trends*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D065840:Protective Factors; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology / Q000331:legislation & jurisprudence / Q000639:trends*; D016540:Smoking Cessation / Q000331:legislation & jurisprudence / Q000379:methods*; D000074606:Smoking Prevention; D013997:Time Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects / Q000331:legislation & jurisprudence / Q000517:prevention & control*
chemical_list: D014028:Tobacco Smoke Pollution
keywords: Acute coronary syndrome; Poisson regression; hospital reports; passive smoking; smoking ban