Article Text

Download PDFPDF
Original article
Effect of smoke-free legislation on the incidence of sudden circulatory arrest in the Netherlands
  1. Dianne de Korte-de Boer1,
  2. Daniel Kotz2,
  3. Wolfgang Viechtbauer3,
  4. Emiel van Haren4,
  5. Devina Grommen2,
  6. Michelle de Munter2,
  7. Harry Coenen5,
  8. Anton P M Gorgels4,
  9. Onno C P van Schayck2
  1. 1Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
  2. 2Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
  3. 3Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
  4. 4Department of Cardiology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
  5. 5Emergency Medical Service, Public Health Service South Limburg, Geleen, The Netherlands
  1. Correspondence to Dianne de Korte-de Boer, Department of Epidemiology, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands; dianne.dekorte{at}


Objective To investigate whether smoke-free legislation in the Netherlands led to a decreased incidence of out-of-hospital sudden circulatory arrest (SCA). Smoke-free legislation was implemented in two phases: a workplace ban in 2004 and an extension of this ban to the hospitality sector on 1 July 2008.

Design Weekly incidence data on SCA were obtained from the ambulance registry of South Limburg, the Netherlands. Three time periods were distinguished: the pre-ban period (1 January 2002–1 January 2004), the first post-ban period (1 January 2004–1 July 2008) and the second post-ban period (1 July 2008–1 May 2010). Trends in absolute SCA incidence were analysed using Poisson regression, adjusted for population size, ambient temperature, air pollution and influenza rates.

Results A total of 2305 SCA cases were observed (mean weekly incidence 5.3±2.3 SD). The adjusted Poisson regression model showed a small but significant increase in SCA incidence during the pre-ban period (+0.20% cases per week, p=0.044). This trend changed significantly after implementation of the first ban (with −0.24% cases per week, p=0.043), translating into a 6.8% (22 cases) reduction in the number of SCA cases after 1 year of smoke-free legislation. No further decrease was seen after the second smoking ban.

Conclusions After introduction of a nationwide workplace smoking ban in 2004, a significant decrease in the incidence of out-of-hospital SCA was seen in South Limburg. Poor enforcement of the 2008 hospitality sector ban may account for the fact that no further decrease in the incidence of SCA was seen at this time.

  • Tobacco smoking
  • environmental tobacco smoke
  • tobacco control
  • sudden circulatory arrest
  • public health
  • smoking
  • sudden cardiac death
  • ventricular fibrillation
  • arrhythmias
  • heart failure
  • 12 lead ECG
  • myocardial ischaemia and infarction (IHD)

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • See Editorial, p 961

  • Funding This work was supported with an unrestricted educational grant by MIRO—innovation in smoking cessation. MIRO is a collaboration between CAPHRI (Maastricht School for Public Health and Primary Care) and Pfizer Inc.

  • Competing interests None declared.

  • Ethics approval Ethics approval was provided by the medical ethical commitee of Maastricht University Medical Centre.

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

Linked Articles