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【NEJM】禁烟立法与因急性冠脉综合症的住院
Jill P. Pell, M.D., Sally Haw, B.Sc., Stuart Cobbe, M.D., David E. Newby, Ph.D., Alastair C.H. Pell, M.D., Colin Fischbacher, M.B., Ch.B., Alex McConnachie, Ph.D., Stuart Pringle, M.D., David Murdoch, M.B., Ch.B., Frank Dunn, M.D., Keith Oldroyd, M.D., Paul MacIntyre, M.D., Brian O'Rourke, M.D., and William Borland, B.Sc.
ABSTRACT
Background Previous studies have suggested a reduction in the total number of hospital admissions for acute coronary syndrome after the enactment of legislation banning smoking in public places. However, it is unknown whether the reduction in admissions involved nonsmokers, smokers, or both.
Methods Since the end of March 2006, smoking has been prohibited by law in all enclosed public places throughout Scotland. We collected information prospectively on smoking status and exposure to secondhand smoke based on questionnaires and biochemical findings from all patients admitted with acute coronary syndrome to nine Scottish hospitals during the 10-month period preceding the passage of the legislation and during the same period the next year. These hospitals accounted for 64% of admissions for acute coronary syndrome in Scotland, which has a population of 5.1 million.
Results Overall, the number of admissions for acute coronary syndrome decreased from 3235 to 2684 — a 17% reduction (95% confidence interval, 16 to 18) — as compared with a 4% reduction in England (which has no such legislation) during the same period and a mean annual decrease of 3% (maximum decrease, 9%) in Scotland during the decade preceding the study. The reduction in the number of admissions was not due to an increase in the number of deaths of patients with acute coronary syndrome who were not admitted to the hospital; this latter number decreased by 6%. There was a 14% reduction in the number of admissions for acute coronary syndrome among smokers, a 19% reduction among former smokers, and a 21% reduction among persons who had never smoked. Persons who had never smoked reported a decrease in the weekly duration of exposure to secondhand smoke (P<0.001 by the chi-square test for trend) that was confirmed by a decrease in their geometric mean concentration of serum cotinine from 0.68 to 0.56 ng per milliliter (P<0.001 by the t-test).
Conclusions The number of admissions for acute coronary syndrome decreased after the implementation of smoke-free legislation. A total of 67% of the decrease involved nonsmokers. However, fewer admissions among smokers also contributed to the overall reduction.
Smoke-free Legislation and Hospitalizations for Acute Coronary Syndrome
禁烟立法与因急性冠脉综合症的住院
ABSTRACT
摘要：
Background Previous studies have suggested a reduction in the total number of hospital admissions for acute coronary syndrome after the enactment of legislation banning smoking in public places. However, it is unknown whether the reduction in admissions involved nonsmokers, smokers, or both.
背景：既往的研究显示公共场所禁烟立法减少因急性冠脉综合症的住院总数。但是，减少的住院来自于非吸烟者、吸烟者还是两者均有尚不清楚。
Methods Since the end of March 2006, smoking has been prohibited by law in all enclosed public places throughout Scotland. We collected information prospectively on smoking status and exposure to secondhand smoke based on questionnaires and biochemical findings from all patients admitted with acute coronary syndrome to nine Scottish hospitals during the 10-month period preceding the passage of the legislation and during the same period the next year. These hospitals accounted for 64% of admissions for acute coronary syndrome in Scotland, which has a population of 5.1 million.
方法：从2006年3月起，苏格兰立法禁止公共场合吸烟。我们采用基于问卷和生化指标的方法前瞻性的收集了法律实施前10个月和实施后1年同样时间段因急性冠脉综合症在9个苏格兰医院住院的患者的吸烟状态和二手烟暴露情况。这些医院接受了苏格兰64%的急性冠脉综合症患者，针对510万人群。
Results Overall, the number of admissions for acute coronary syndrome decreased from 3235 to 2684 — a 17% reduction (95% confidence interval, 16 to 18) — as compared with a 4% reduction in England (which has no such legislation) during the same period and a mean annual decrease of 3% (maximum decrease, 9%) in Scotland during the decade preceding the study. The reduction in the number of admissions was not due to an increase in the number of deaths of patients with acute coronary syndrome who were not admitted to the hospital; this latter number decreased by 6%. There was a 14% reduction in the number of admissions for acute coronary syndrome among smokers, a 19% reduction among former smokers, and a 21% reduction among persons who had never smoked. Persons who had never smoked reported a decrease in the weekly duration of exposure to secondhand smoke (P<0.001 by the chi-square test for trend) that was confirmed by a decrease in their geometric mean concentration of serum cotinine from 0.68 to 0.56 ng per milliliter (P<0.001 by the t-test).
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作者:admin@医学,生命科学 2011-05-27 17:14
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