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Impact of Scotland's comprehensive, smoke-free legislation on stroke

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  • Daniel F. Mackay
  • Sally Haw
  • David E. Newby
  • Peter Langhorne
  • Suzanne M. Lloyd
  • Alex McConnachie
  • Jill P. Pell

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    Rights statement: Copyright: © 2013 Mackay et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0062597
Original languageEnglish
Article number62597
Number of pages6
JournalPLoS ONE
Volume8
Issue number5
DOIs
Publication statusPublished - 8 May 2013

Abstract

Background

Previous studies have reported a reduction in acute coronary events following smoke-free legislation. Evidence is lacking on whether stroke is also reduced. The aim was to determine whether the incidence of stroke, overall and by sub-type, fell following introduction of smoke-free legislation across Scotland on 26 March 2006.

Methods and Findings

A negative binomial regression model was used to determine whether the introduction of smoke-free legislation resulted in a step and/or slope change in stroke incidence. The model was adjusted for age-group, sex, socioeconomic deprivation quintile, urban/rural residence and month. Interaction tests were also performed. Routine hospital administrative data and death certificates were used to identify all hospital admissions and pre-hospital deaths due to stroke (ICD10 codes I61, I63 and I64) in Scotland between 2000 and 2010 inclusive. Prior to the legislation, rates of all stroke, intracerebral haemorrhage and unspecified stroke were decreasing, whilst cerebral infarction was increasing at 0.97% per annum. Following the legislation, there was a dramatic fall in cerebral infarctions that persisted for around 20 months. No visible effect was observed for other types of stroke. The model confirmed an 8.90% (95% CI 4.85, 12.77, p<0.001) stepwise reduction in cerebral infarction at the time the legislation was implemented, after adjustment for potential confounders.

Conclusions

Following introduction of national, comprehensive smoke-free legislation there was a selective reduction in cerebral infarction that was not apparent in other types of stroke.

    Research areas

  • ACUTE MYOCARDIAL-INFARCTION, CIGARETTE-SMOKING, SECONDHAND SMOKE, PASSIVE SMOKING, ISCHEMIC-STROKE, RISK-FACTOR, HOSPITAL ADMISSIONS, CHINESE WOMEN, HEART-DISEASE, IMPLEMENTATION

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