Hospital admissions and costs for acute myocardial infarction, asthma and appendicitis before and after implementation of Rhode Island's statewide smoke-free ordinance

Objective: We examined the short- and longer-term effects of Rhode Island's comprehensive statewide smoking ban on hospital admissions and costs for two diagnoses for which there is evidence of a causal relationship with secondhand smoke exposure.

Methods: We used Hospital Discharge Data to analyze trends in age-adjusted rates and costs (adjusted for inflation) for acute myocardial infarction (AMI), asthma, and appendicitis (control) for patients aged18+ before and after implementation of the ban in 2005 (Pre-Ban: 2003-2004; Post-Ban: 2006-2007 and 2008-2009). The ban was assumed to be a causal factor if (1) there was an immediate and sustained reduction in admissions and (2) the reduction was statistically significant compared to the Pre-ban period. These analyses are being extended with Poisson regression.

Results: The smoke-free ordinance was associated with a significant reduction in AMI admission rates from 2003 (35.2 per 10,000 population; 95% CI 34.0-36.5) to 2009 (23.1; 95% CI 22.1-24.1), an increase in hospitalization rates for asthma from 2003 (11.3; 95% CI 10.6-12.1) to 2009 (13.5; 12.8-14.3), with no change for appendicitis. Changes in total reimbursement costs over the same period showed a 14.6% reduction for AMI, 55.1% increase for asthma, and 13.7% increase for appendicitis.

Conclusion: Initial findings illustrate the positive public health impact of Rhode Island's statewide smoke-free ordinance, and add to evidence suggesting that smoke-free legislation is associated with declining rates and costs in AMI admissions. Further research is needed to better understand the increase in admission rates and costs for asthma and to address potential study limitations.