European Heart Journal Advance Access originally published online on July 30, 2007
European Heart Journal 2007 28(18):2296-2297; doi:10.1093/eurheartj/ehm303
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Short-term effects of Italian smoking regulation on rates of hospital admission for acute myocardial infarction: reply
Biomedical sciences and Human Oncology
University of Turin
Via Santena 7
10126 Turin
Italy
Cancer Epidemiology Unit
CeRMS and Center for Oncologic Prevention
University of Turin
Via Santena 7
10126 Turin
Italy
Cancer Epidemiology Unit
CeRMS and Center for Oncologic Prevention
University of Turin
Via Santena 7
10126 Turin
Italy
Cancer Epidemiology Unit
CeRMS and Center for Oncologic Prevention
University of Turin
Via Santena 7
10126 Turin
Italy
E-mail address: fbaroneadesi{at}yahoo.it
Broome et al.1 suggest that our estimate of a 11% decrease in hospital admissions for acute myocardial infarction (AMI) during the first 5 months after the introduction of the Italian smoking ban in January 2005 might be biased.2 They base their argument on three points, which are in our opinion incorrect.
First, we chose a priori to analyse the 5-month period (February–June 2005) after the introduction of the ban because, at the time of submission of our manuscript, data from the regional Hospital Discharge Registry were available till June 2005. However, restriction of the analysis to the 3-month period February–April 2005 would also give a 11% overall reduction (95% confidence interval: 21–0%; P = 0.05) among persons aged <60.
Secondly, the rate ratio (RR) of 0.89 that we estimated in our paper was not due mainly to the RR of 0.75 among women: it is the weighted average of 0.91 among men and 0.75 among women, in which the weight for men is 85%, whereas that for women is 15%. This is because, among people aged <60, AMI was much commoner in men than in women.
Thirdly, as our estimates were more strongly influenced by the rates for men than by those for women, it is more important to consider the background trend in admissions for AMI of men than for women. As also shown in Table 1 of our original article,1 the rates of admissions for AMI per 1000 person-years among men aged <60 were 1.21 in 2001, 1.25 in 2002, 1.31 in 2003, 1.35 in 2004 and 1.24 in 2005, indicating, if anything, an increasing trend up to 2004. Therefore, adjustment for the background trend would have given an even higher estimate of the effect of the ban.
We thank Broome et al.1 for giving us the opportunity to clarify these points, which, in our opinion, add plausibility to the hypothesis of an association between implementation of smoking bans and a decrease in AMI.1,3,4
References
- Barone-Adesi F, Vizzini L, Merletti F, Richiardi L. Short-term effects of Italian smoking regulation on rates of hospital admission for acute myocardial infarction. Eur Heart J (2006) 27:2468–2472.
[Abstract/Free Full Text] - Broome RA, Beveridge CH, Williams ES. Short-term effects of Italian smoking regulation on rates of hospital admission for acute myocardial infarction. Eur Heart J (2007) Published online ahead of print February 22; doi:10.1093/eurheartj/ehl568.
- Sargent RP, Shepard RM, Glantz SA. Reduced incidence of admissions for myocardial infarction associated with public smoking ban: before and after study. BMJ (2004) 328:977–980.
[Abstract/Free Full Text] - Bartecchi C, Alsever RN, Nevin-Woods C, Thomas WM, Estacio RO, Bartelson BB, Krantz MJ. Reduction in the incidence of acute myocardial infarction associated with a citywide smoking ordinance. Circulation (2006) 114:1490–1496.
[Abstract/Free Full Text]
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