Swiss Tropical and Public Health Institute, Basel, Switzerland.
Eur J Public Health. 2011 Jun;21(3):316-22. doi: 10.1093/eurpub/ckq142. Epub 2010 Oct 6.
Introducing comprehensive smoke-free policies to public places is expected to reduce health costs. This includes prevented health damages by avoiding environmental tobacco smoke (ETS) exposure as well as indirect health benefits from reduced tobacco consumption.
The aim of this study was to estimate direct health costs of ETS exposure in public places and indirect health benefits from reduced tobacco consumption. We calculated attributable hospital days and years of life lost (YLL), based on the observed passive smoking and disease rates in Switzerland. The exposure-response associations of all relevant health outcomes were derived by meta-analysis from prospective cohort studies in order to calculate the direct health costs. To assess the indirect health benefits, a meta-analysis of smoking ban studies on hospital admissions for acute myocardial infarction was conducted.
ETS exposure in public places in Switzerland causes 32,000 preventable hospital days (95% CI: 10,000-61,000), 3000 YLL (95% CI: 1000-5000), corresponding to health costs of 330 Mio CHF. The number of hospital days for ischaemic heart disease attributable to passive smoking is much larger if derived from smoking ban studies (41,000) than from prospective cohort studies (3200), resulting in additional health costs of 89 Mio CHF, which are attributed to the indirect health benefits of a smoking ban introduction.
The example of smoking ban studies on ischaemic heart disease hospitalization rates suggests that total health costs that can be prevented with smoking bans are considerably larger than the costs arising from the direct health impact of ETS exposure in public places.
在公共场所引入全面禁烟政策有望降低卫生成本。这包括通过避免接触环境烟草烟雾（ETS）以及减少烟草消费带来的间接健康益处来预防健康损害。
本研究旨在估计公共场所 ETS 暴露的直接健康成本和减少烟草消费带来的间接健康益处。我们根据瑞士观察到的被动吸烟和疾病率，计算了归因于医院住院日和生命损失年（YLL）。所有相关健康结果的暴露-反应关联均通过前瞻性队列研究的荟萃分析得出，以计算直接健康成本。为了评估间接健康益处，对急性心肌梗死住院的禁烟研究进行了荟萃分析。
瑞士公共场所的 ETS 暴露导致 32000 例可预防的医院住院日（95%CI：10000-61000）和 3000 例 YLL（95%CI：1000-5000），相应的健康成本为 3.30 亿瑞士法郎。如果从禁烟研究中得出，归因于被动吸烟的缺血性心脏病住院天数（41000）比从前瞻性队列研究中得出的要大得多（3200），这导致额外的健康成本 8900 万瑞士法郎，归因于禁烟引入的间接健康益处。
以缺血性心脏病住院率的禁烟研究为例，可通过禁烟预防的总健康成本远远大于公共场所 ETS 暴露直接健康影响所产生的成本。
