Hospital Admissions for Heart Attack Decline Due to State Clean Indoor Air Act

Most Extensive Study to Date Links the Act to Improved Health Outcomes

ALBANY, N.Y. (Sept. 27, 2007) – New Yorkers are having fewer heart attacks, thanks to the state's Clean Indoor Air Act that took effect in July 2003, according to a study to be published today by the American Journal of Public Health.

The state Department of Health study found 3,813 fewer hospital admissions for heart attacks in 2004, an 8 percent decline, than would be expected in New York without a comprehensive indoor smoking ban. Fewer hospital admissions translate into direct health care cost savings of $56 million in 2004 alone.

"The dramatic decline in heart attacks shows that New York’s law is working to reduce the health consequences of exposure to toxins in secondhand smoke,” said state Health Commissioner Richard F. Daines, M.D. "While previous studies have shown that non-smokers’ exposure to secondhand smoke was dramatically reduced following the implementation of the state Clean Indoor Air Act, this study goes further by showing a direct correlation with improved health.”

“The number of heart attacks has been declining for years in New York due to improvements in clinical care and other factors. This study was able to account for these changes and detect the increase in the rate of decline as a result of the Clean Indoor Air Act,” said Harlan Juster, Ph.D., Director of New York state’s Tobacco Control Program Surveillance and Evaluation Team. "This study is the largest of its kind, analyzing data spanning a 10-year period and including all nonfederal hospital admissions in the state.”

Nationally, secondhand smoke is estimated to kill 35,000 non-smokers from coronary heart disease every year. Laboratory research has shown that tobacco smoke from the burning end of a cigarette or exhaled from a smoker's lungs can induce cardiovascular changes in non-smokers. Even modest exposures to secondhand smoke have been shown to have adverse impacts. According to a 2006 Surgeon General's Report, there is no safe level of exposure to secondhand smoke.

The study notes that the clinical implications of these results are most relevant for patients with existing cardiac conditions. While secondhand smoke can be harmful to everyone, cardiac patients must be extremely careful to avoid exposure to secondhand smoke. Physicians with cardiac patients who smoke should advise them to quit, and those who do not smoke should be advised to avoid any exposure to secondhand smoke.

The study is consistent with findings of previous studies that comprehensive smoking bans are associated with significant and meaningful reductions in the rate of hospitalizations for heart attack. Before this landmark study, the state Health Department released findings on the benefits of reduced exposure to secondhand smoke earlier this summer in the Morbidity and Mortality Weekly Report, published by the federal Centers for Disease Control and Prevention (see http://www.nyhealth.gov/press/releases/2007/2007-07-19_second_hand_smoke.htm).

Russ Sciandra, Director of the Center for a Tobacco Free New York, said, “In 2003, New York’s leaders looked at the facts and rightly decided that the right to breathe clean air trumps the license to smoke. This study demonstrates the wisdom of that decision: all New Yorkers are benefiting from safer environments, improved public health and lower health care costs because of the Clean Indoor Air Act.”

"The findings in this study confirm the public health benefits of the enactment of the Clean Indoor Air Act," said Paul Hartman, Senior Director of Advocacy for the American Heart Association. Hartman was involved in advocating for the passage of the Clean Indoor Air Act.

"The risk of death from coronary heart disease increases by up to 30 percent among people regularly exposed to secondhand smoke at home or work,” Mr. Hartman added. “Thousands of New Yorkers are clearly benefiting from the Clean Indoor Air Act, which removed this risk factor from worksites across the state. We commend New York's lawmakers for taking this bold step forward to protect the health of workers across New York. Clearly, the Clean Indoor Air Act is helping New Yorkers live longer, healthier lives."

Study Highlights

• In 2004, there were 3,813 fewer hospital admissions for acute myocardial infarction than would have been expected in the absence of the comprehensive smoking ban, an 8 percent reduction. These figures are over and above the impact of pre-existing laws, changes in clinical care, and secular trends.
• Direct health care cost savings of $56 million were realized as a result of reduced hospitalizations in 2004.
• This study adds to the evidence that comprehensive smoke-free laws have real health impacts that begin soon after the law takes effect.

Title: Declines in Hospital Admissions for Acute Myocardial Infarction in New York State After Implementation of a Comprehensive Smoking Ban

Authors and Affiliations:

• Harlan Juster, Ph.D, New York State Department of Health;
• Brett Loomis, M.S., Research Triangle Institute International;
• Theresa Hinman, M.P.H., New York State Department of Health;
• Matthew Farrelly, Ph.D., Research Triangle Institute International;
• Andrew Hyland, Ph.D., Roswell Park Cancer Institute;
• Ursula Bauer, Ph.D., M.P.H., New York State Department of Health;
• Guthrie Birkhead, M.D., M.P.H., New York State Department of Health

Methods: Trends in county-level, age-adjusted, monthly hospital admission rates for acute myocardial infarction and stroke were analyzed from 1995 to 2004, to identify any association between admission rates and implementation of the comprehensive indoor smoking ban in July 2003. The analysis controlled for the effects of pre-existing local and statewide laws, seasonal trends, geographic differences, and secular trends that included changes in the clinical care and new medications.

Findings: In 2004, there were 3,813 fewer hospital admissions for acute myocardial infarction than would have been expected in the absence of the comprehensive smoking ban. There was no change in admissions for stroke associated with the smoking ban.

Implications: This is the largest study to date showing an association between smoking bans and reductions in hospital admissions for acute myocardial infarctions.