Abstract 5133: Does Public Smoking Ban Reduce the Incidence of Myocardial Infarction in Michigan? A Systematic Review and Attributable Risk Analysis
Background: Smoking is a well-established risk factor for cardiovascular disease. The Michigan legislature is currently considering a proposal for a comprehensive smoking ban (CSB) in Michigan. The potential impact of such a law on the incidence AMI is not known. We conducted a meta-analysis to study the impact of CSB on the incidence of AMI and calculated the impact of potential CSB on the incidence of AMI in Michigan.
Methods: We searched MEDLINE, EMBASE, and Cochrane databases from inception till May 2008 for studies comparing the rates of AMI hospital admissions before and in the year after the implementation of CSB legislation. Of 135 potentially relevant articles screened initially, 5 studies met the inclusion criteria. A random-effects model meta-analysis was done and between-studies heterogeneity was compared with I2. The attributable risk (AR) of CSB on AMI incidence was calculated and multiplied with the number of AMI admissions in Michigan.
Results: In the published studies, a CSB was associated with a decrease in the incidence of AMI (RR 96%, 95% CI 93%–100%, p=0.05). There was no heterogeneity between the included studies (I2<50%). The AR of CSB on the incidence of AMI is −4.2%. The average number of hospital admissions for AMI as first-listed diagnosis in Michigan between 1999 and 2006 was 27,007 per year. Thus, if a CSB legislation is implemented in Michigan in 2008, the calculated reduction of hospital admissions for AMI is 1130 admissions per year as of 2009..
Conclusion: CSB is associated with a significant reduction of annual hospital admissions for AMI. The financial impact of this reduction on health care cost is yet to be determined.