Impact of a Partial Smoke-Free Legislation on Myocardial Infarction Incidence, Mortality and Case-Fatality in a Population-Based Registry: The REGICOR Study

Abstract

Background and ObjectiveCoronary 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.MethodsUsing 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).ResultsIn 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.ConclusionsThe 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.

Age, Period, and Cohort Effects on Mortality From Ischemic Heart Disease in Southern Spain

“…In addition, because the main reduction in risk factors is still to be produced, as a result of the Integrated Health Plans implemented by the Department of Health of the Autonomous Government of Andalusia in 2005, the decline of mortality may accelerate in the next few years. 56,57 CONCLUSIONS Age-period-cohort effects on mortality from ischemic heart disease were similar in all the provinces of Andalusia and for Andalusia as a whole. The cohort effect showed a steady fall in the mortality risk for male and female generations born after 1920.…”

Risk of Cause-Specific Death in Individuals With Diabetes: A Competing Risks Analysis

“…Several studies have shown alteration in the diabetes course by introducing changes in health promotion activities (e.g., screening and support in achieving lifestyle modifications), in the clinical management of such diseases (e.g., intensive control of cardiovascular risk factors), in health systems (e.g., functional multidisciplinary units for the management of diabetes), and in society as a whole (e.g., smoking ban policies) (30)(31)(32)(33)(34)(35). This multidisciplinary approach may partially explain the annual 3% decrease in cardiovascular mortality observed in individuals with diabetes in the United States; however, the pattern in individuals without such disease has been much lower (36)(37)(38).…”

Disability-adjusted Life Years Lost to Ischemic Heart Disease in Spain

“…[13][14][15][16][17][18][19][20][21][22][23][24] However, most of these studies focused on specific regions of Spain or covered incident cases from the 1990s, before troponin analysis was routinely used in the diagnosis of acute myocardial infarction. Because of these limitations, we decided to draw on the information in the Spanish Registry of Hospital Discharges (Minimum Basic Data Set), 25 which has been used in several studies on acute myocardial infarction.…”