Ong Michael K, Glantz Stanton A
Division of General Internal Medicine, Department of Medicine, University of California, San Francisco 94143-1390, USA.
Am J Med. 2004 Jul 1;117(1):32-8. doi: 10.1016/j.amjmed.2004.02.029.
Smoking is the leading controllable risk factor for heart disease. Only about 69% of U.S. indoor workers are currently covered by a smoke-free workplace policy. This analysis projects the cardiovascular health and economic effects of making all U.S. workplaces smoke free after 1 year and at steady state.
We estimated the number of U.S. indoor workers not covered by smoke-free workplace policies, and the effects of making all workplaces smoke free on smoking behavior and on the relative risks of acute myocardial infarctions and strokes. One-year and steady-state results were calculated using an exponential decline model. A Monte Carlo simulation was performed for a sensitivity analysis.
The first-year effect of making all workplaces smoke free would produce about 1.3 million new quitters and prevent over 950 million cigarette packs from being smoked annually, worth about 2.3 billion dollars in pretax sales to the tobacco industry. In 1 year, making all workplaces smoke free would prevent about 1500 myocardial infarctions and 350 strokes, and result in nearly $60 [corrected] in savings in direct medical costs. At steady state, 6250 myocardial infarctions and 1270 strokes would be prevented, and $279 million [corrected] would be saved in direct medical costs annually. Reductions in passive smoking would account for 60% of effects among acute myocardial infarctions.
Making all U.S. workplaces smoke free would result in considerable health and economic benefits within 1 year. Reductions in passive smoking would account for a majority of these savings. Similar effects would occur with enactment of state or local smoke-free policies.
吸烟是心脏病的首要可控风险因素。目前，美国只有约69%的室内工作者受无烟工作场所政策覆盖。本分析预测了美国所有工作场所实现无烟一年后及达到稳定状态时对心血管健康和经济的影响。
我们估算了未受无烟工作场所政策覆盖的美国室内工作者数量，以及所有工作场所实现无烟对吸烟行为、急性心肌梗死和中风相对风险的影响。使用指数下降模型计算一年期和稳定状态的结果。进行蒙特卡洛模拟以进行敏感性分析。
所有工作场所实现无烟的第一年效果将产生约130万新戒烟者，每年可防止超过9.5亿包香烟被吸食，这对烟草行业来说相当于约23亿美元的税前销售额。在1年内，所有工作场所实现无烟将预防约1500例心肌梗死和350例中风，并使直接医疗成本节省近60美元[校正后]。在稳定状态下，将预防6250例心肌梗死和1270例中风，每年可节省直接医疗成本2.79亿美元[校正后]。被动吸烟的减少将占急性心肌梗死影响的60%。
美国所有工作场所实现无烟将在1年内带来可观的健康和经济效益。被动吸烟的减少将占这些节省的大部分。州或地方无烟政策的颁布也会产生类似效果。
