Association between the extension of smoke-free legislation and incident acute myocardial infarctions in Singapore from 2010 to 2019: an interrupted time-series analysis
Background We examined the association between smoke-free laws implemented in the outdoors and the common areas of residential apartment blocks and reported acute myocardial infarctions (AMI) in Singapore.Methods We used an interrupted time-series design and seasonal autoregressive integrated moving...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-10-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/8/10/e012339.full |
| _version_ | 1797628108433522688 |
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| author | Joel Aik Nan Liu Huili Zheng Eric Jou Jamie S Y Ho Andrew F W Ho |
| author_facet | Joel Aik Nan Liu Huili Zheng Eric Jou Jamie S Y Ho Andrew F W Ho |
| author_sort | Joel Aik |
| collection | DOAJ |
| description | Background We examined the association between smoke-free laws implemented in the outdoors and the common areas of residential apartment blocks and reported acute myocardial infarctions (AMI) in Singapore.Methods We used an interrupted time-series design and seasonal autoregressive integrated moving average models to examine the effect of the smoke-free law extensions in 2013 (common areas of residential blocks, covered pedestrian linkways, overhead bridges and within 5 m of bus stops), 2016 (parks) and 2017 (educational institutions, buses and taxis) on the monthly incidence rate of AMIs per 1 000 000 population.Results We included 133 868 AMI reports from January 2010 to December 2019. Post-2013, there was a decrease in the AMI incidence trend (β=−0.6 per month, 95%CI −1.0 to –0.29) and 2097 (95% CI 2094 to 2100) more AMIs may have occurred without the extension. There was a significant step-decline in male AMIs and a non-significant step-increase in female AMIs post-2013. Those 65 years and older experienced a greater decline to the postlegislation 2013 trend (β=−5.9, 95% CI −8.7 to –3.1) compared with those younger (β=−0.4, 95% CI −0.6 to –0.2), while an estimated 19 591 (15 711 to 23472) additional AMI cases in those 65 years and above may have occurred without the extension. We found a step-increase in monthly AMI incidence post-2016 (β=14.2, 95%CI 3.3 to 25.0).Conclusion The 2013 smoke-free law extension to residential estates and other outdoor areas were associated with a decline in AMIs and those above the age of 65 years and men appeared to be major beneficiaries. Additional epidemiological evidence is required to support the expanded smoke-free legislation to parks, educational institutions, buses and taxis. |
| first_indexed | 2024-03-11T10:33:49Z |
| format | Article |
| id | doaj.art-afdb49a68e7b40d6b05184e298bb2a4c |
| institution | Directory Open Access Journal |
| issn | 2059-7908 |
| language | English |
| last_indexed | 2024-03-11T10:33:49Z |
| publishDate | 2023-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj.art-afdb49a68e7b40d6b05184e298bb2a4c2023-11-14T11:40:07ZengBMJ Publishing GroupBMJ Global Health2059-79082023-10-0181010.1136/bmjgh-2023-012339Association between the extension of smoke-free legislation and incident acute myocardial infarctions in Singapore from 2010 to 2019: an interrupted time-series analysisJoel Aik0Nan Liu1Huili Zheng2Eric Jou3Jamie S Y Ho4Andrew F W Ho5Programme in Health Services and Systems Research, Duke-NUS Medical School, SingaporeProgramme in Health Services and Systems Research, Duke-NUS Medical School, SingaporeNational Registry of Diseases Office, Health Promotion Board, SingaporeQueens` College, University of Cambridge, Cambridge, UKDepartment of Medicine, National University Hospital, National University Health System, SingaporeProgramme in Health Services and Systems Research, Duke-NUS Medical School, SingaporeBackground We examined the association between smoke-free laws implemented in the outdoors and the common areas of residential apartment blocks and reported acute myocardial infarctions (AMI) in Singapore.Methods We used an interrupted time-series design and seasonal autoregressive integrated moving average models to examine the effect of the smoke-free law extensions in 2013 (common areas of residential blocks, covered pedestrian linkways, overhead bridges and within 5 m of bus stops), 2016 (parks) and 2017 (educational institutions, buses and taxis) on the monthly incidence rate of AMIs per 1 000 000 population.Results We included 133 868 AMI reports from January 2010 to December 2019. Post-2013, there was a decrease in the AMI incidence trend (β=−0.6 per month, 95%CI −1.0 to –0.29) and 2097 (95% CI 2094 to 2100) more AMIs may have occurred without the extension. There was a significant step-decline in male AMIs and a non-significant step-increase in female AMIs post-2013. Those 65 years and older experienced a greater decline to the postlegislation 2013 trend (β=−5.9, 95% CI −8.7 to –3.1) compared with those younger (β=−0.4, 95% CI −0.6 to –0.2), while an estimated 19 591 (15 711 to 23472) additional AMI cases in those 65 years and above may have occurred without the extension. We found a step-increase in monthly AMI incidence post-2016 (β=14.2, 95%CI 3.3 to 25.0).Conclusion The 2013 smoke-free law extension to residential estates and other outdoor areas were associated with a decline in AMIs and those above the age of 65 years and men appeared to be major beneficiaries. Additional epidemiological evidence is required to support the expanded smoke-free legislation to parks, educational institutions, buses and taxis.https://gh.bmj.com/content/8/10/e012339.full |
| spellingShingle | Joel Aik Nan Liu Huili Zheng Eric Jou Jamie S Y Ho Andrew F W Ho Association between the extension of smoke-free legislation and incident acute myocardial infarctions in Singapore from 2010 to 2019: an interrupted time-series analysis BMJ Global Health |
| title | Association between the extension of smoke-free legislation and incident acute myocardial infarctions in Singapore from 2010 to 2019: an interrupted time-series analysis |
| title_full | Association between the extension of smoke-free legislation and incident acute myocardial infarctions in Singapore from 2010 to 2019: an interrupted time-series analysis |
| title_fullStr | Association between the extension of smoke-free legislation and incident acute myocardial infarctions in Singapore from 2010 to 2019: an interrupted time-series analysis |
| title_full_unstemmed | Association between the extension of smoke-free legislation and incident acute myocardial infarctions in Singapore from 2010 to 2019: an interrupted time-series analysis |
| title_short | Association between the extension of smoke-free legislation and incident acute myocardial infarctions in Singapore from 2010 to 2019: an interrupted time-series analysis |
| title_sort | association between the extension of smoke free legislation and incident acute myocardial infarctions in singapore from 2010 to 2019 an interrupted time series analysis |
| url | https://gh.bmj.com/content/8/10/e012339.full |
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