Differences in Mortality Rates from Acute Myocardial Infarction after Implementation of a Comprehensive State-wide Smoking Ban in NY State

Background: In New York State, a comprehensive state-wide ban prohibiting smoking in all workplaces, restaurants and bars took effect in 2003. This was associated with decreased hospital admission rates for acute myocardial infarction (AMI). Objective: Describe AMI mortality in New York (NY) and in all US States with no smoking ban before or after the action in NY as of 2010 (AK, AL, IN, KY, MS, MO, OK, SC, TX, WVA, WY = NOBAN). Methods: The CDC WONDER Compressed Mortality File provided yearly age-adjusted (25-85+ years) rates and 95% Confidence Intervals (CI) for 1999-2007 according to race, gender, ethnicity, and urbanization. Analyses were restricted to groups with reliable rates. Results: In Large Central Cities, NY mortality for Non-Hispanic White Women was significantly higher than that for NOBAN states in 1999 and 2001-2003, but there was no statistical difference in 2004-2007. A similar pattern was observed for Non-Hispanic White Men. In contrast, there was a protective effect associated with residence in less urban areas of NY that either decreased or was lost after the smoking ban. Results for other racial and ethnic groups were mixed, but were mostly positive in large central metro and large fringe metro areas. Conclusions: Benefits of smoking cessation for AMI mortality in NY relative to NOBAN states may have been modified by characteristics associated with race, gender, ethnicity and/or urbanization. Adverse effects may have occurred in less urban areas. Analytic epidemiologic investigation is needed to assure maximum benefit from laws related to smoking cessation.