Meta-analysis of the effect of comprehensive smoke-free legislation on acute coronary events

Mackay, D.F. , Irfan, M.O., Haw, S. and Pell, J.P. (2010) Meta-analysis of the effect of comprehensive smoke-free legislation on acute coronary events. Heart, 96(19), pp. 1525-1530. (doi: 10.1136/hrt.2010.199026)

Abstract

<p>Objective To assess the evidence for a reduced risk of acute coronary events following comprehensive smoke-free legislation.</p> <p>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.</p> <p>Main outcome measure Acute coronary events.</p> <p>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 I-2=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).</p> <p>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.</p>

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Mackay, Professor Daniel and Pell, Professor Jill
• Authors: Mackay, D.F., Irfan, M.O., Haw, S., and Pell, J.P.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Centre for Population and Health Sciences
• Journal Name: Heart
• ISSN: 1355-6037
• ISSN (Online): 1468-201X
• Published Online: 23 August 2010