Séguret Fabienne, Ferreira Christelle, Cambou Jean-Pierre, Carrière Isabelle, Thomas Daniel
Department of Epidemiology, Biostatistics and Medical Information, University Hospital, Montpellier, France
Department of Epidemiology, Biostatistics and Medical Information, University Hospital, Montpellier, France.
Eur J Prev Cardiol. 2014 Dec;21(12):1575-82. doi: 10.1177/2047487313500569. Epub 2013 Aug 5.
The impact of a comprehensive stepwise smoking ban (2007 and 2008) was assessed by analysing the hospitalization rate for acute coronary syndrome (ACS) in France, between 2003 and 2009.
Between 2003 and 2009, 867,164 hospitalizations for ACS were observed among about 23 million administrative reports. The age-and gender-standardized hospitalization rates were calculated and their variation before and after the smoking ban implementation was investigated by Poisson regression that included the ACS seasonal variations and the historical trend. The hospitalization rate decreased by 12.8% (from 269 to 235/100,000) with a significant historical trend reduction (p < 0.10(-3)) in all groups, but in young women. After adjusting for linear trend, reductions linked to the ban remained not significant in all groups: relative risk (RR) from 0.96 (95% CI 0.91-1.01) in men older than 55 years to 0.99 (95% CI 0.93-1.04) in men aged 55 years or less after the first phase, and from 0.96 (95% CI 0.89-1.04) in men older than 55 years to 1.03 (95% CI 0.94-1.12) in women older than 65 years after the second phase of the ban.
This study did not demonstrate a significant effect of a two-phases smoking ban on ACS hospitalization rate. A steadily decrease of this rate over the 7-year period, the past preventive measures in France leading to low levels of passive smoking, and the significant increase in active smoking during the studied period may explain this result. Our study highlights the difficulty of proving an effect of smoking bans in a country with an already low ACS incidence.
通过分析2003年至2009年间法国急性冠状动脉综合征（ACS）的住院率，评估全面逐步禁烟令（2007年和2008年）的影响。
2003年至2009年间，在约2300万份行政报告中观察到867164例ACS住院病例。计算年龄和性别标准化住院率，并通过泊松回归研究禁烟令实施前后其变化情况，该回归分析纳入了ACS的季节性变化和历史趋势。住院率下降了12.8%（从269/10万降至235/10万），所有组（年轻女性除外）的历史趋势均显著下降（p＜0.10⁻³）。在调整线性趋势后，与禁烟令相关的降幅在所有组中仍不显著：第一阶段后，55岁以上男性的相对风险（RR）为0.96（95%可信区间0.91 - 1.01），55岁及以下男性为0.99（95%可信区间0.93 - 1.04）；第二阶段禁烟令后，55岁以上男性的RR为0.96（95%可信区间0.89 - 1.04），65岁以上女性为1.03（95%可信区间0.94 - 1.12）。
本研究未证明两阶段禁烟令对ACS住院率有显著影响。该比率在7年期间稳步下降、法国过去的预防措施导致被动吸烟水平较低以及研究期间主动吸烟显著增加可能解释了这一结果。我们的研究凸显了在一个ACS发病率已经较低的国家证明禁烟令效果的困难。
