Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2018;71:726-34 - Vol. 71 Num.09 DOI: 10.1016/j.rec.2017.10.055

Impact of 2 Successive Smoking Bans on Hospital Admissions for Cardiovascular Diseases in Spain

Iñaki Galán a,b,, Lorena Simón a, Elena Boldo a,c,d, Cristina Ortiz a, María José Medrano a, Rafael Fernández-Cuenca a,c, Cristina Linares e, Roberto Pastor-Barriuso a,c

a Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
b Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid/IdiPAZ, Madrid, Spain
c CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
d Instituto de Investigación Sanitaria Puerta del Hierro, Madrid, Spain
e Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain

Keywords

Acute myocardial infarction. Ischemic heart disease. Cerebrovascular diseases. Hospital admissions. Smoking ban.

Abstract

Introduction and objectives

To evaluate the impact of 2 smoking bans enacted in 2006 (partial ban) and 2011 (comprehensive ban) on hospitalizations for cardiovascular disease in the Spanish adult population.

Methods

The study was performed in 14 provinces in Spain. Hospital admission records were collected for acute myocardial infarction (AMI), ischemic heart disease (IHD), and cerebrovascular disease (CVD) in patients aged ≥ 18 years from 2003 through 2012. We estimated immediate and 1-year effects with segmented-linear models. The coefficients for each province were combined using random-effects multivariate meta-analysis models.

Results

Overall, changes in admission rates immediately following the implementation of the partial ban and 1 year later were –1.8% and +1.2% for AMI, +0.1 and +0.4% for IHD, and +1.0% and +2.8% for CVD (P > .05). After the comprehensive ban, immediate changes were –2.3% for AMI, –2.6% for IHD, and –0.8% for CVD (P > .05), only to return to precomprehensive ban values 1 year later. For patients aged ≥ 65 years of age, immediate changes associated with the comprehensive ban were –5.0%, –3.9%, and –2.3% for AMI, IHD, and CVD, respectively (P < .05). Again, the 1-year changes were not statistically significant.

Conclusions

In Spain, smoking bans failed to significantly reduce hospitalizations for AMI, IHD, or CVD among patients ≥ 18 years of age. In the population aged ≥ 65 years, hospital admissions due to these diseases showed significant decreases immediately after the implementation of the comprehensive ban, but these reductions disappeared at the 1-year evaluation.

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1885-5857/© 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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