title: Assessing the effects of the Spanish partial smoking ban on cardiovascular and respiratory diseases: methodological issues.
abstract: OBJECTIVE
  Recent research has assessed the impact of tobacco laws on cardiovascular and respiratory morbidity. In this study, we also examined whether the association between the implementation of the 2005 Spanish smoking ban and hospital admissions for cardiovascular and respiratory diseases varies according to the adjustment for potential confounders.
  
  
  METHODS
  Ecological time series analysis.
  
  
  METHODS
  Residents of Madrid and Barcelona cities (Spain).
  
  
  RESULTS
  Data on daily emergency room admissions for acute myocardial infarction, cerebrovascular disease, chronic obstructive pulmonary disease (COPD), and asthma derived from the 2003-2006 Spanish hospital admissions registry.
  
  
  METHODS
  Changes in admission rates between 2006 and the 2003-2005 period were estimated using additive Poisson models allowing for overdispersion adjusted for secular trend in admission, seasonality, day of the week, temperature, number of flu and acute respiratory infection cases, pollution levels, tobacco consumption prevalence and, for asthma cases, pollen count.
  
  
  RESULTS
  In Madrid, fully adjusted models failed to detect significant changes in hospital admission rates for any disease during the study period. In Barcelona, however, hospital admissions decreased by 10.2% (95% CI 3.8% to 16.1%) for cerebrovascular diseases and by 16.0% (95% CI 7.0% to 24.1%) for COPD. Substantial changes in effect estimates were observed on adjustment for linear or quadratic trend. Effect estimates for asthma-related admissions varied substantially when adjusting for pollen count in Madrid, and for seasonality and tobacco consumption in Barcelona.
  
  
  CONCLUSIONS
  Our results confirm that the potential impact of a smoking ban must be adjusted for the underlying secular trend. In asthma-related admissions, pollen count, seasonality and tobacco consumption must be specified in the model. The substantial variability in effects detected between the two cities of Madrid and Barcelona lends strong support for a nationwide study to assess the overall effect of a smoking ban in Spain and identify the causes of the observed heterogeneity.
authors.affiliation: National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ, Madrid, Spain.
authors.forename: Iñaki
authors.initials: I
authors.lastname: Galán
authors.affiliation: National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Lorena
authors.initials: L
authors.lastname: Simón
authors.affiliation: National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Víctor
authors.initials: V
authors.lastname: Flores
authors.affiliation: National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Ortiz
authors.affiliation: National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Fernández-Cuenca
authors.affiliation: National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Linares
authors.affiliation: National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Puerta de Hierro Biomedical Research Institute, Madrid, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Boldo
authors.affiliation: National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Medrano
authors.affiliation: National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Pastor-Barriuso
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016012:Poisson Distribution; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D012042:Registries; D012044:Regression Analysis; D061845:Smoke-Free Policy / Q000331:legislation & jurisprudence*; D012907:Smoking / Q000009:adverse effects / Q000331:legislation & jurisprudence; D000074606:Smoking Prevention; D013030:Spain / Q000453:epidemiology; D014028:Tobacco Smoke Pollution / Q000009:adverse effects* / Q000331:legislation & jurisprudence / Q000517:prevention & control; D055815:Young Adult
chemical_list: D014028:Tobacco Smoke Pollution
keywords: EPIDEMIOLOGY; PUBLIC HEALTH