title: Acute respiratory and cardiovascular admissions after a public smoking ban in Geneva, Switzerland.
abstract: BACKGROUND
  Many countries have introduced legislations for public smoking bans to reduce the harmful effects of exposure to tobacco smoke. Smoking bans cause significant reductions in admissions for acute coronary syndromes but their impact on respiratory diseases is unclear. In Geneva, Switzerland, two popular votes led to a stepwise implementation of a state smoking ban in public places, with a temporary suspension. This study evaluated the effect of this smoking ban on hospitalisations for acute respiratory and cardiovascular diseases.
  
  
  METHODS
  This before and after intervention study was conducted at the University Hospitals of Geneva, Switzerland, across 4 periods with different smoking legislations. It included 5,345 patients with a first hospitalisation for acute coronary syndrome, ischemic stroke, acute exacerbation of chronic obstructive pulmonary disease, pneumonia and acute asthma. The main outcomes were the incidence rate ratios (IRR) of admissions for each diagnosis after the final ban compared to the pre-ban period and adjusted for age, gender, season, influenza epidemic and secular trend.
  
  
  RESULTS
  Hospitalisations for acute exacerbation of chronic obstructive pulmonary disease significantly decreased over the 4 periods and were lowest after the final ban (IRR=0.54 [95%CI: 0.42-0.68]). We observed a trend in reduced admissions for acute coronary syndromes (IRR=0.90 [95%CI: 0.80-1.00]). Admissions for ischemic stroke, asthma and pneumonia did not significantly change.
  
  
  CONCLUSIONS
  A legislative smoking ban was followed by a strong decrease in hospitalisations for acute exacerbation of chronic obstructive pulmonary disease and a trend for reduced admissions for acute coronary syndrome. Smoking bans are likely to be very beneficial for patients with chronic obstructive pulmonary disease.
authors.affiliation: Division of Primary Care Medicine, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Humair
authors.affiliation: Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland; Division of Internal Medicine, Chablais Regional Hospital, Monthey, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Garin
authors.affiliation: Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland; Division of Ambulatory Care and Emergency Medicine, Clinique La Colline, Geneva, Switzerland.
authors.forename: Eric
authors.initials: E
authors.lastname: Gerstel
authors.affiliation: Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Carballo
authors.affiliation: Division of Cardiology, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Carballo
authors.affiliation: Division of Cardiology, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Pierre-Frédéric
authors.initials: PF
authors.lastname: Keller
authors.affiliation: Unit of Population Epidemiology, Division of Primary Care Medicine, University Hospitals of Geneva, Geneva, Switzerland; Community Prevention Unit, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Idris
authors.initials: I
authors.lastname: Guessous
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology* / Q000209:etiology; D000208:Acute Disease; D000368:Aged; D001249:Asthma / Q000453:epidemiology / Q000209:etiology; D002545:Brain Ischemia / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006291:Health Policy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000209:etiology; D012907:Smoking / Q000009:adverse effects / Q000331:legislation & jurisprudence*; D013557:Switzerland / Q000453:epidemiology; D014028:Tobacco Smoke Pollution / Q000331:legislation & jurisprudence; D014505:Urban Population
chemical_list: D014028:Tobacco Smoke Pollution