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Reductions in Cardiovascular, Cerebrovascular, and Respiratory Mortality following the National Irish Smoking Ban: Interrupted Time-Series Analysis

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Stallings-Smith, Sericea, Zeka, Ariana, Goodman, Pat, Kabir, Zubair, Clancy, Luke·2013·PLoS ONE
DOI 10.1371/journal.pone.0062063PMC PMC3634756
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Abstract

BACKGROUND: Previous studies have shown decreases in cardiovascular mortality following the implementation of comprehensive smoking bans. It is not known whether cerebrovascular or respiratory mortality decreases post-ban. On March 29, 2004, the Republic of Ireland became the first country in the world to implement a national workplace smoking ban. The aim of this study was to assess the effect of this policy on all-cause and cause-specific, non-trauma mortality. METHODS: A time-series epidemiologic assessment was conducted, utilizing Poisson regression to examine weekly age and gender-standardized rates for 215,878 non-trauma deaths in the Irish population, ages ≥35 years. The study period was from January 1, 2000, to December 31, 2007, with a post-ban follow-up of 3.75 years. All models were adjusted for time trend, season, influenza, and smoking prevalence. RESULTS: Following ban implementation, an immediate 13% decrease in all-cause mortality (RR: 0.87; 95% CI: 0.76-0.99), a 26% reduction in ischemic heart disease (IHD) (RR: 0.74; 95% CI: 0.63-0.88), a 32% reduction in stroke (RR: 0.68; 95% CI: 0.54-0.85), and a 38% reduction in chronic obstructive pulmonary disease (COPD) (RR: 0.62; 95% CI: 0.46-0.83) mortality was observed. Post-ban reductions in IHD, stroke, and COPD mortalities were seen in ages ≥65 years, but not in ages 35-64 years. COPD mortality reductions were found only in females (RR: 0.47; 95% CI: 0.32-0.70). Post-ban annual trend reductions were not detected for any smoking-related causes of death. Unadjusted estimates indicate that 3,726 (95% CI: 2,305-4,629) smoking-related deaths were likely prevented post-ban. Mortality decreases were primarily due to reductions in passive smoking. CONCLUSIONS: The national Irish smoking ban was associated with immediate reductions in early mortality. Importantly, post-ban risk differences did not change with a longer follow-up period. This study corroborates previous evidence for cardiovascular causes, and is the first to demonstrate reductions in cerebrovascular and respiratory causes.

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  • Studies of the effects of smoke-free laws found that hospital admission and mortality rates for cardiovascular and respiratory conditions decreased after implementation of smoking bans.

    “Studies of the effects of smoke-free laws found that hospital admission and mortality rates for cardiovascular and respiratory conditions decreased after the implementation of smoking bans455–459.”

    From Health effects associated with exposure to secondhand smoke: a Burden of Proof study (2024) · cites this paper as [455]

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  1. [22]Central Statistics Office Ireland (2011) Census Interactive Tables for Censuses 1996, 2002, 2006. Available: http://census.cso.ie/census/ReportFolders/ReportFolders.aspx?CS_referer=&CS_ChosenLang=en. Accessed 2011 Mar 30.

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Authors
Stallings-Smith, S., Zeka, A., Goodman, P., Kabir, Z., & Clancy, L.
Affiliations
  • Brunel University of London (GB)
  • University College Cork (IE)
  • TobaccoFree Research Institute (IE)
Corresponding author
Zeka, Ariana
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2013-04-24
Volume
8
Issue
4
Pages
e62063
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0062063
PMC
PMC3634756
OpenAlex
W21590284
Cited by
99
References
42
Citations by year
2026: 2 · 2025: 4 · 2024: 4 · 2023: 7 · 2022: 8 · 2021: 4 · 2020: 7 · 2019: 13 · 2018: 4 · 2017: 4 · 2016: 10 · 2015: 11 · 2014: 15 · 2013: 6
FWCI
9.75
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Arrow@dit (Dublin Institute of Technology) (acceptedVersion)
  • Brunel University Research Archive (BURA) (Brunel University London) (submittedVersion, cc-by)
  • Cork Open Research Archive (University College Cork, Ireland) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
  • Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
Keywords
workplace smoking bans, smoke-free workplaces, passive smoking, cardiovascular mortality, cerebrovascular disease mortality, respiratory mortality, ischemic heart disease, stroke, chronic obstructive pulmonary disease, all-cause mortality, smoking-related deaths, Ireland, tobacco control, age and sex differences in mortality, smoking prevalence, smoking cessation referral, smoking cessation services
MeSH terms
Smoking Prevention, Adult, Age Factors, Aged, Aged, 80 and over, Cardiovascular Diseases, Female, Humans, Ireland, Male, Middle Aged, Respiratory Tract Diseases, Sex Factors, Time Factors, Poisson Distribution

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