Gender, Smoke-free Laws and Reduction in Hospitalizations for Acute Myocardial Infarction

Smoke-free workplace and public places legislation are linked to significant declines in hospitalizations for AMI in the general population. Few studies have evaluated whether smoke-free laws that protect only some sectors of the workforce impact the incidence of AMI at the community level. The purpose was to examine the effect of a smoke-free enclosed public places law on hospitalizations for AMI and to determine if there were gender differences given the lack of coverage for all workplaces. AMI events were measured using hospital discharge diagnosis 40 months prior to and 32 months after the enforcement of Lexington-Fayette County Kentucky's smoke-free public places law on April 27, 2004. Case inclusion criteria were: 1) 35 years and older; 2) primary discharge diagnosis of AMI (ICD-9 codes 410.00-410.99); and 3) occurred between January 1, 2001 and December 31, 2006. Among women, AMI hospitalizations declined 22% from pre- to post-law. The rate of AMI events among men did not change significantly from pre- to post-law. This is the first study to examine the effects of a non-comprehensive smoke-free law on AMI rates. The overrepresentation of women in the hospitality industry in Fayette County combined with the disproportionate number of men working in manufacturing facilities not mandated by the smoke-free law, may partially explain why women may be more protected by the smoke-free law than men. Enacting comprehensive smoke-free laws that cover all places of employment and strengthening existing partial laws may extend protection against AMIs to both male and female workers.