实施禁烟令后急性心肌梗死住院人数减少。
Reduction in acute myocardial infarction hospitalization after implementation of a smoking ordinance.
机构信息
Colorado School of Public Health, University of Colorado, Aurora, USA.
出版信息
Am J Med. 2011 Jul;124(7):647-54. doi: 10.1016/j.amjmed.2011.02.022.
BACKGROUND
Smoking ordinances have been associated with reduced acute myocardial infarction rates, but nearly all studies lack patient-level data.
OBJECTIVE
We determined whether a smoking ordinance was associated with a reduction in hospitalizations for acute myocardial infarction, irrespective of smoking status and infarct presentation (ST elevation vs. non-ST elevation).
METHODS
Detailed chart abstraction of biomarkers to confirm first acute myocardial infarction events was performed from the single community hospital serving Greeley, Colorado and adjacent zip codes, 17 months before and 31 months after implementing a public smoking ordinance. Poisson regression analysis, adjusted for population growth, was used to assess changes in mean incidence rates.
RESULTS
A total of 706 hospitalizations were identified from July 2002 through June 2006: 482 among Greeley city residents and 224 within adjacent zip code areas. A postordinance reduction in hospitalizations was observed in Greeley (relative risk [RR] 0.73; 95% confidence interval [CI], 0.59-0.90). A smaller, nonsignificant decrease was noted in the area immediately surrounding Greeley (RR 0.83; 95% CI, 0.61-1.14). However, the comparison of relative risk reductions between Greeley and the surrounding area was not significant (P=.48). The reduction in Greeley was more pronounced among smokers (RR 0.44; 95% CI, 0.29-0.65) than nonsmokers (RR 0.86; 95% CI, 0.67-1.09) and did not differ by acute myocardial infarction presentation (P=.38).
CONCLUSIONS
A smoking ordinance was associated with a decrease in acute myocardial infarction hospitalizations of a magnitude similar to previous reports, but could not be distinguished from the adjacent geographic area. Reductions were greatest among smokers, despite previous studies suggesting that benefits accrue primarily among nonsmokers. Smoke-free policy may therefore exert a beneficial effect among smokers, who are disproportionately exposed to direct and sidestream smoke.
背景
吸烟禁令与急性心肌梗死发生率降低有关，但几乎所有研究都缺乏患者层面的数据。
目的
我们旨在确定吸烟禁令是否与急性心肌梗死住院率降低相关，而不论患者的吸烟状况和梗死表现（ST 段抬高与非 ST 段抬高）如何。
方法
对科罗拉多州格里利市（Greeley）及其毗邻邮政编码地区的单家社区医院进行了详细的图表摘录，以确认首次急性心肌梗死事件，研究时间为实施公共吸烟禁令前 17 个月和后 31 个月。采用泊松回归分析，调整人口增长因素，评估平均发病率的变化。
结果
2002 年 7 月至 2006 年 6 月期间，共确定了 706 例住院治疗：482 例为格里利市居民，224 例来自毗邻的邮政编码区。在实施禁令后，格里利市的住院人数减少（相对风险 [RR] 0.73；95%置信区间 [CI]，0.59-0.90）。在紧邻格里利市的地区，观察到较小但无统计学意义的下降（RR 0.83；95% CI，0.61-1.14）。然而，格里利市与周边地区相对风险降低的比较没有统计学意义（P=.48）。在吸烟者中，这种减少更为明显（RR 0.44；95% CI，0.29-0.65），而非吸烟者（RR 0.86；95% CI，0.67-1.09），且与急性心肌梗死的表现无关（P=.38）。
结论
吸烟禁令与急性心肌梗死住院率的降低相关，其程度与以往报告相似，但与相邻的地理区域无法区分。减少幅度在吸烟者中最大，尽管先前的研究表明，主要受益人群是非吸烟者。因此，禁烟政策可能会对吸烟者产生有益影响，因为他们过多地暴露于直接和侧流烟雾中。
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