Smoking restrictions and hospitalization for acute coronary events in Germany
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To study the effects of smoking restrictions in Germany on coronary syndromes and their associated costs.
Methods and results
All German states implemented laws partially restricting smoking in the public and hospitality sectors between August 2007 and July 2008. We conducted a before-and-after study to examine trends for the hospitalization rate for angina pectoris and acute myocardial infarction (AMI) for an insurance cohort of 3,700,384 individuals 30 years and older. Outcome measures were hospitalization rates for coronary syndromes, and hospitalization costs. Mean age of the cohort was 56 years, and two-thirds were female. Some 2.2 and 1.1% persons were hospitalized for angina pectoris and AMI, respectively, during the study period from January 2004 through December 2008. Law implementation was associated with a 13.3% (95% confidence interval 8.2, 18.4) decline in angina pectoris and an 8.6% (5.0, 12.2) decline in AMI after 1 year. Hospitalization costs also decreased significantly for the two conditions—9.6% (2.5, 16.6) for angina pectoris and 20.1% (16.0, 24.2) for AMI at 1 year following law implementation. Assuming the law caused the observed declines, it prevented 1,880 hospitalizations and saved 7.7 million Euros in costs for this cohort during the year following law implementation.
Partial smoking restrictions in Germany were followed by reductions in hospitalization for angina pectoris and AMI, declines that continued through 1 year following these laws and resulted in substantial cost savings. Strengthening the laws could further reduce morbidity and costs from acute coronary syndromes in Germany.
KeywordsSmoking ban Cardiovascular diseases Hospitalizations Costs Germany
Deutsche Angestellten-Krankenkasse (DAK), a German health insurance firm, provided the data for the analysis and some funding to support the data analysis. Dr. Sargent receives funding from the National Institutes of Health (CA 77026).
Conflict of interest
- 1.Peto R, Lopez AD, Boreham J, Thun M, Heath C (1994) Mortality from smoking in developed countries 1950–2000. Indirect estimates from national vital statistics. Oxford University Press, OxfordGoogle Scholar
- 4.Sherif MA, Nienaber CA, Toelg R, Abdel-Wahab M, Geist V, Schneider S et al (2011) Impact of smoking on the outcome of patients treated with drug-eluting stents: 1-year results from the prospective multicentre German Drug-Eluting Stent Registry (DES.DE). Clin Res Cardiol 100(5):413–423PubMedCrossRefGoogle Scholar
- 5.US Department of Health and Human Services (2006) The health consequences of involuntary exposure to tobacco: a report of the Surgeon General. US Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and HealthGoogle Scholar
- 16.Centers for Disease Control and Prevention (CDC) (2009) Reduced hospitalizations for acute myocardial infarction after implementation of a smoke-free ordinance–City of Pueblo, Colorado, 2002–2006. MMWR Morb Mortal Wkly Rep 57(51):1373–1377Google Scholar
- 32.Villalbi JR, Sanchez E, Benet J, Cabezas C, Castillo A, Guarga A et al (2011) The extension of smoke-free areas and acute myocardial infarction mortality: before and after study. BMJ Open 1(1):000067Google Scholar
- 36.Müller S, Kraus L, Piontek D, Pabst A (2011) Changes in exposure to secondhand smoke and smoking behavior. Sucht 56(5):3–373Google Scholar
- 37.Bickel PJ (2001) Mathematical statistics, 2nd edn. Prentice-Hall, Upper Saddle River, NJGoogle Scholar
- 39.Lampert M, List SM (2010) Tabak-Zahlen und Fakten zum Konsum. In: Deutsche Hauptstelle für Suchtfragen (ed) Jahrbuch Sucht 2010. Neuland, Geesthacht, pp 48–68Google Scholar
- 41.Tebbe U, Messer C, Stammwitz E, The GS, Dietl J, Bischoff KO et al (2007) Reduction of in-hospital mortality and improved secondary prevention after acute myocardial infarction. First results from the registry of secondary prevention after acute myocardial infarction (SAMI). Dtsch Med Wochenschr 132(30):1559–1566PubMedCrossRefGoogle Scholar
- 42.The Joint European Society of Cardiology/American College of Cardiology Committee (2000) Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Eur Heart J 21(18):1502–1513Google Scholar
- 44.Gu YL, Voors AA, Zijlstra F, Hillege HL, Struck J, Masson S et al (2011) Comparison of the temporal release pattern of copeptin with conventional biomarkers in acute myocardial infarction. Clin Res Cardiol 100(12):1069–1076Google Scholar
- 46.Meiser F (2008) Effect of the modified definition of the myocardial infarct using troponin for diagnosis, therapy, and process of NSTEMI in clinical daily routine in Germany [Einfluss der geänderten Definition des Myokardinfarktes unter Berücksichtigung der Troponine auf Diagnose, Therapie und Verlauf des NSTEMI im klinischen Alltag in Deutschland]. Doctoral thesis, University of Heidelberg, HeidelbergGoogle Scholar
- 47.IOM (Institute of Medicine) (2010) Secondhand smoke exposure and cardiovascular effects: making sense of the evidence. The National Academy Press, Washington, DCGoogle Scholar