243570 Differences in Mortality Rates from Acute Myocardial Infarction after Implementation of a Comprehensive State-wide Smoking Ban in NY State

Monday, October 31, 2011

Malgorzata Hasek, MD, MPH , Department of Family Medicine, Division of Preventive Medicine, Meharry Medical College, Nashville, TN
Robert S. Levine, MD , Department of Family & Community Medicine, Meharry Medical College, Nashville, TN
Barbara Kilbourne, MD , Department of Family Medicine, Meharry Medical College, Nashville, TN
Roger Zoorob, MD, MPH , Department of Family and Community Medicine, Meharry Medical College, Nashville, TN
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.

Learning Areas:
Epidemiology
Public health or related public policy

Learning Objectives:
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)

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I am a resident physician in the field of preventive medicine.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.