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Meta-analysis of the effect of comprehensive smoke-free legislation on acute coronary events
  1. D F Mackay1,
  2. M O Irfan1,
  3. S Haw2,
  4. J P Pell1
  1. 1Section of Public Health, University of Glasgow, Glasgow, UK
  2. 2Scottish Collaboration for Public Health Research and Policy, Edinburgh, UK
  1. Correspondence to Jill Pell, Room 305, Public Health Section, University of Glasgow, Glasgow G12 8RZ, UK; j.pell{at}clinmed.gla.ac.uk

Abstract

Objective To assess the evidence for a reduced risk of acute coronary events following comprehensive smoke-free legislation.

Methods Two independent systematic reviews were undertaken using PubMed, Embase and Science Direct with no date restrictions imposed. Meta-analysis was undertaken using a random effects model to obtain a pooled estimate of the relative risk. Linear regression was used to examine possible bias and meta-regression was used to investigate possible causes of heterogeneity.

Main outcome measure Acute coronary events.

Results The 17 eligible studies (10 from North America, 6 from Europe and 1 from Australasia) provided 35 estimates of effect size. Apart from five subgroup analyses, all of the published results suggested a reduction in the incidence of acute coronary events following the introduction of smoke-free legislation. Meta-analysis produced a pooled estimate of the relative risk of 0.90 (95% CI 0.86 to 0.94). There was significant heterogeneity (overall I2=95.1%, p<0.001) but there was no evidence of small study bias (p=0.714). On univariate random effects meta-regression analysis, studies with longer data collection following legislation produced greater estimates of risk reduction and remained significant after adjustment for other study characteristics (adjusted coefficient −0.005, 95% CI −0.007 to −0.002, multiplicity adjusted p=0.006).

Conclusions There is now a large body of evidence supporting a reduction in acute coronary events following the implementation of comprehensive smoke-free legislation, with the effect increasing over time from implementation. Countries that have not yet adopted smoke-free legislation should be encouraged to do so.

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Footnotes

  • Funding NHS Health Scotland project grant.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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