スコットランドにおける公共の場での禁煙法実施の効果(NEJM)

Smoke-free Legislation and Hospitalizations for Acute Coronary Syndrome
Jill P. Pell, M.D.　et al. NEJM　Volume 359:482-491 July 31, 2008 Number 5

病院で見ているので，もしかしたらアクセス権が必要かも．

ABSTRACT

Background Previous studies have suggested a reduction in the total number of hospital admissions for acute coronary syndrome after the enactment of legislation banning smoking in public places. However, it is unknown whether the reduction in admissions involved nonsmokers, smokers, or both.

Methods Since the end of March 2006, smoking has been prohibited by law in all enclosed public places throughout Scotland. We collected information prospectively on smoking status and exposure to secondhand smoke based on questionnaires and biochemical findings from all patients admitted with acute coronary syndrome to nine Scottish hospitals during the 10-month period preceding the passage of the legislation and during the same period the next year. These hospitals accounted for 64% of admissions for acute coronary syndrome in Scotland, which has a population of 5.1 million.

Results Overall, the number of admissions for acute coronary syndrome decreased from 3235 to 2684 — a 17% reduction (95% confidence interval, 16 to 18) — as compared with a 4% reduction in England (which has no such legislation) during the same period and a mean annual decrease of 3% (maximum decrease, 9%) in Scotland during the decade preceding the study. The reduction in the number of admissions was not due to an increase in the number of deaths of patients with acute coronary syndrome who were not admitted to the hospital; this latter number decreased by 6%. There was a 14% reduction in the number of admissions for acute coronary syndrome among smokers, a 19% reduction among former smokers, and a 21% reduction among persons who had never smoked. Persons who had never smoked reported a decrease in the weekly duration of exposure to secondhand smoke (P<0.001 by the chi-square test for trend) that was confirmed by a decrease in their geometric mean concentration of serum cotinine from 0.68 to 0.56 ng per milliliter (P<0.001 by the t-test).

Conclusions The number of admissions for acute coronary syndrome decreased after the implementation of smoke-free legislation. A total of 67% of the decrease involved nonsmokers. However, fewer admissions among smokers also contributed to the overall reduction.

日本で言う健康増進法のようなものの実施によって，ACS（急性冠動脈症候群）による入院が，喫煙者でも，非喫煙者でも減ったということ．

こういったRCTのない単純介入による研究は，その介入と結果の因果関係の証明が難しい．

この研究がやっている工夫

他国と比べる（こういった法律を実施していない英国の同期間の減少率が４％に対して　１７％減少）
法律施行前と比べる

非喫煙者でも減っていることは実際のACSの減少と，受動喫煙の総計時間の自己報告，血中のコチニン濃度の減少にて示している．

table 2
皆さんも見られるとよいのですが．

法律施行前後で，喫煙経験者（以前の喫煙者），非喫煙者両者に置いて
自宅，他人の家，車，バス，電車では変化なし
パブ（スコットランドといえば！），バー，クラブ，その他の公共の場所では減少

喫煙経験者に置いてのみ
仕事場での受動喫煙時間減少

ただしこれはself reporting biasがあるかもしれません．

該当する人数が多い場合は公衆衛生的なアプローチ．（勿論個別の禁煙指導もですが）
日本は健康増進法で何かが変わったか．タスポ導入では？

この研究は法律施行前後の１０ヶ月ずつ計２０ヶ月のデータ．日本でもできるはず．