Abstract 4008: The Burden of Coronary Heart Disease Attributable to Passive Smoking Remains Large
Introduction: Passive smoking is a risk factor for coronary heart disease (CHD).
Goal: Our goal is to estimate the annual myocardial infarctions (MI) and CHD deaths due to passive smoking by exposure source.
Methods: The events are estimated as a function of passive smoking, given current active smoking prevalence. We used national surveys to determine the prevalence of passive smoking by self report and level of serum cotinine (≥ 0.1 and ≥ 0.05 ng/mL), and by source of exposure. We evaluate the passive burden in year 2006. The Base Case assumes passive smoking remains at levels existing in 2000 to 2002. The Trend Case assumes that reductions in passive smoking continue at the trends between 2000 and 2002. Annual events were estimated by age and sex specific exposures, and allocated by proportion of each subgroup reporting each source of exposure. Estimates were calculated using the CHD Policy Model. The Model uses recent estimates of average relative risk due to passive smoking, which indicate the excess risk due to average daily passive smoking is equivalent to one cigarette per day, about 1/3 the excess CHD risk of actively smoking one pack/day. The Model is calibrated to reproduce, in its baseline year of 2000, all key outcomes in the U.S. to within 1%, as well as the results of relevant clinical trials.
Results: In the Base Case passive smoking causes 11,000 to 21,200 CHD deaths and 18,500 to 32,000 MIs annually. Between 14% and 62% of these events are due to workplace exposure, and a large fraction of exposure is based on the measured serum cotinine level of persons who do not report any exposure to environmental tobacco smoke (Table⇓). In the Trend Case, the number of events is reduced by between 23% and 45% by 2006.
Conclusion: Passive smoking produces a significant burden of CHD. It remains a major workplace hazard, even given recent trends in reduction of exposure. Based on serum cotinine levels, significant passive smoking and resulting CHD occur in persons with no self-report of exposure.