title: A review of the evidence on smoking bans and incidence of heart disease.
abstract: We update an earlier review of smoking bans and heart disease, restricting attention to admissions for acute myocardial infarction. Forty-five studies are considered. New features of our update include consideration of non-linear trends in the underlying rate, a modified trend adjustment method where there are multiple time periods post-ban, comparison of estimates based on changes in rates and numbers of cases, and comparison of effect estimates according to post-ban changes in smoking restrictiveness. Using a consistent approach to derive ban effect estimates, taking account of linear time trends and control data, the reduction in risk following a ban was estimated as 4.2% (95% confidence interval 1.8-6.5%). Excluding regional estimates where national estimates are available, and studies where trend adjustment was not possible, the estimate reduced to 2.6% (1.1-4.0%). Estimates were little affected by non-linear trend adjustment, where possible, or by basing estimates on changes in rates. Ban effect estimates tended to be greater in smaller studies, and studies with greater post-ban changes in smoking restrictiveness. Though the findings suggest a true effect of smoking bans, uncertainties remain, due to the weakness of much of the evidence, the small estimated effect, and various possibilities of bias.
authors: P.N. Lee Statistics and Computing Ltd., 17 Cedar Road, Sutton, Surrey SM2 5DA, UK. Electronic address: PeterLee@pnlee.co.uk.
authors: Peter N
authors: PN
authors: Lee
authors: P.N. Lee Statistics and Computing Ltd., 17 Cedar Road, Sutton, Surrey SM2 5DA, UK.
authors: John S
authors: JS
authors: Fry
authors: P.N. Lee Statistics and Computing Ltd., 17 Cedar Road, Sutton, Surrey SM2 5DA, UK.
authors: Barbara A
authors: BA
authors: Forey
mesh_terms: D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D009203:Myocardial Infarction / Q000453:epidemiology*; D012907:Smoking / Q000331:legislation & jurisprudence; D000074606:Smoking Prevention; D013997:Time Factors
keywords: Cessation; Heart disease; Smoking bans; Tobacco