Association of anti-smoking legislation with rates of hospital admission for cardiovascular and respiratory conditions

While this study convincingly shows that there was a major decline in cardiovascular disease admissions in Toronto after implementation of its smoking ban, an analysis of the actual data fails to support the conclusion that this decline was attributable to the smoking ban.

The central analysis necessary to answer this basic research question is not conducted in this paper: a comparison of the magnitude of decline in cardiovascular disease admissions in Toronto versus the comparison cities. The data on changes in cardiovascular disease admissions in the comparison cities are not provided or analyzed in the paper; they are relegated to an appendix.

However, if one examines those data, one finds that both comparison cities experienced quite dramatic declines in cardiovascular disease admissions during the study period, and that the magnitude of those declines was similar to those observed in Toronto.

For example, while the rate of angina admissions in Toronto declined by about 60% from 2001-2006, the rate in Durham region declined by 59% during the same time period.

While the rate of heart attack admissions in Toronto declined by 28% from 2001-2006, the rate in Thunder Bay declined by 28%.

And the rates of decline in stroke admissions in Toronto and Durham region from 2001-2006 were identical, at about 35%.

The overall decline in cardiovascular disease admissions in Toronto from 2001-2006 was about 42%, compared to about 38% in Durham region.

Looking just at the period 2001-2004, cardiovascular disease admissions in Toronto declined by about 29%, compared to 31% in Durham region.

These data do not support the conclusion that the observed decline in cardiovascular disease admissions in Toronto is attributable to the smoking ban.

While smoking bans are an important public health intervention because they protect nonsmokers from the known hazards of secondhand smoke exposure, more rigorous scientific analysis is necessary before concluding that these policies result in immediate and dramatic reductions in acute cardiovascular events.

Conflict of Interest:

None declared