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Lee J, Han AR, Choi D, Lim KM, Bae S. Modeling lifetime costs and health outcomes attributable to secondhand smoke exposure at home among Korean adult women. BMJ Open 2017; 7:e013292. [PMID: 28515183 PMCID: PMC5623422 DOI: 10.1136/bmjopen-2016-013292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aim of this research is to estimate lifetime costs and health consequences for Korean adult women who were exposed to secondhand smoke (SHS) at home. METHODS A Markov model was developed to project the lifetime healthcare costs and health outcomes of a hypothetical cohort of Korean women who are 40 years old and were married to current smokers. The Korean epidemiological data were used to reflect the natural history of SHS-exposed and non-exposed women. The direct healthcare costs (in 2014 US dollars) and quality-adjusted life years (QALYs) were annually discounted at 5% to reflect time preference. The time horizon of the analysis was lifetime and the cycle length was 1 year. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS In the absence of SHS exposure, Korean women will live 41.32 years or 34.56 QALYs before discount, which corresponded to 17.29 years or 15.35 QALYs after discount. The SHS-exposed women were predicted to live 37.91 years and 31.08 QALYs before discount and 16.76 years and 14.62 QALYs after discount. The estimated lifetime healthcare cost per woman in the SHS non-exposed group was US$11 214 before the discount and US$2465 after discount. The negative impact of SHS exposure on health outcomes and healthcare costs escalated as the time horizon increased, suggesting that the adverse impact of SHS exposure may have higher impact on the later part of the lifetime. The result was consistent across a wide range of assumptions. CONCLUSION Life expectancy might underestimate the impact of SHS exposure on health outcomes, especially if the time horizon of the analysis is not long enough. Early intervention on smoking behaviour could substantially reduce direct healthcare costs and improve quality of life attributable to SHS exposure.
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Affiliation(s)
- Jiyae Lee
- College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea
| | - Ah Ram Han
- College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea
| | - Dalwoong Choi
- Department of Public Health Science, Graduate School, Korea University, Seoul, Republic of Korea
| | - Kyung-Min Lim
- College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea
| | - SeungJin Bae
- College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea
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Hou L, Han W, Jiang J, Liu B, Wu Y, Zou X, Xue F, Chen Y, Zhang B, Pang H, Wang Y, Wang Z, Hu Y, Li J. Passive smoking and stroke in men and women: a national population-based case-control study in China. Sci Rep 2017; 7:45542. [PMID: 28361935 PMCID: PMC5374519 DOI: 10.1038/srep45542] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/27/2017] [Indexed: 12/27/2022] Open
Abstract
An association between passive smoking and stroke is unclear in China, particularly the association with hemorrhagic stroke. This study included 16205 deaths due to stroke aged ≥30 years and 16205 non-stroke controls randomly selected and frequency-matched to cases on gender and age. Smoking of spouses, defined as ≥1 cigarette per day for up to 1 year, was taken as a measure of exposure to passive smoking of subjects that was retrospectively ascertained by interviewing surviving spouses. After adjustment for variables, passive smoking increased the risk of death by 10% (odds ratio (OR), 1.10; 95% confidence interval (CI), 1.05-1.16) for all strokes, by 10% (OR, 1.10; 95% CI, 1.04-1.16) for hemorrhagic stroke, and by 12% (OR, 1.12; 95% CI, 1.03-1.23) for ischemic stroke, compared with non-exposure. This finding was highly consistent in men or women and in smokers or non-smokers, and was generally consistent among zones of China despite geographic diversity. The risk significantly increased with exposure-years and quantity of cigarettes smoked daily by spouses. This study indicated that passive smoking is associated with deaths from all-type strokes. It is highly advisable for the government to promote strong tobacco prevention and cessation programs and smoke-free environments.
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Affiliation(s)
- Lei Hou
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/School of Basic Medicine Peking Union Medical College, Beijing, China
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wei Han
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Jingmei Jiang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Boqi Liu
- Cancer Institute & Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Yanping Wu
- Cancer Institute & Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Xiaonong Zou
- Cancer Institute & Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Fang Xue
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Yuanli Chen
- Cancer Institute & Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Biao Zhang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Haiyu Pang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Yuyan Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Zixing Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Yaoda Hu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Junyao Li
- Cancer Institute & Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
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Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 6130] [Impact Index Per Article: 875.7] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Wang Y, Liu M, Pu C. 2014 Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack. Int J Stroke 2017; 12:302-320. [PMID: 28381199 DOI: 10.1177/1747493017694391] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Ischemic stroke and transient ischemic attack (TIA) are the most common cerebrovascular disorder and leading cause of death in China. The Effective secondary prevention is the vital strategy for reducing stroke recurrence. The aim of this guideline is to provide the most updated evidence-based recommendation to clinical physicians from the prior version. Control of risk factors, intervention for vascular stenosis/occlusion, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke are all recommended, and the prevention of recurrent stroke in a variety of uncommon causes and subtype provided as well. We modified the level of evidence and recommendation according to part of results from domestic RCT in order to facility the clinical practice.
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Affiliation(s)
- Yongjun Wang
- 1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Liu
- 2 Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Chuanqiang Pu
- 3 Department of Neurology, The General Hospital of Chinese People's Liberation Army, Beijing, China
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Jones MR, Magid HS, Al-Rifai M, McEvoy JW, Kaufman JD, Hinckley Stukovsky KD, Szklo M, Polak J, Burke GL, Post WS, Blaha MJ, Navas-Acien A. Secondhand Smoke Exposure and Subclinical Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2016; 5:e002965. [PMID: 27993830 PMCID: PMC5210438 DOI: 10.1161/jaha.115.002965] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 10/14/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Few studies have evaluated the association between secondhand smoke (SHS) and subclinical cardiovascular disease among ethnically diverse populations. This study assesses the impact of SHS on inflammation and atherosclerosis (carotid intima-media thickness, coronary artery calcification, and peripheral arterial disease). METHODS AND RESULTS We examined 5032 nonsmoking adults aged 45 to 84 years without prior cardiovascular disease participating in the Multi-Ethnic Study of Atherosclerosis (MESA) from 2000 to 2002. SHS exposure was determined by self-report, and urinary cotinine was measured in a representative subset (n=2893). The multi-adjusted geometric mean ratios (95% CIs) for high-sensitivity C-reactive protein and interleukin-6 comparing 407 participants with SHS ≥12 h/wk versus 3035 unexposed participants were 1.13 (1.02-1.26) and 1.04 (0.98-1.11), respectively. The multi-adjusted geometric mean ratio for carotid intima-media thickness was 1.02 (0.97-1.07). Fibrinogen and coronary artery calcification were not associated with SHS. The prevalence of peripheral arterial disease (ankle-brachial index ≤0.9 or ≥1.4) was associated with detectable urinary cotinine (odds ratio, 2.10; 95% CI, 1.09-4.04) but not with self-reported SHS. Urinary cotinine was not associated with inflammation or carotid intima-media thickness. CONCLUSIONS Despite limited exposure assessment, this study supports the association of SHS exposure with inflammation and peripheral arterial disease.
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Affiliation(s)
- Miranda R Jones
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Hoda S Magid
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mahmoud Al-Rifai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD
| | - John W McEvoy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD
| | - Joel D Kaufman
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA
| | - Karen D Hinckley Stukovsky
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA
| | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Joseph Polak
- Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA
| | - Gregory L Burke
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston- Salem, NC
| | - Wendy S Post
- Division of Cardiology, Johns Hopkins University, Baltimore, MD
| | - Michael J Blaha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, MD
| | - Ana Navas-Acien
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Lin MP, Ovbiagele B, Markovic D, Towfighi A. Association of Secondhand Smoke With Stroke Outcomes. Stroke 2016; 47:2828-2835. [DOI: 10.1161/strokeaha.116.014099] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 09/12/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Approximately half of never smokers are exposed to secondhand smoke (SHS). Smoking is a well-established stroke risk factor, yet associations between SHS, stroke, and poststroke mortality remain uncertain. We aimed to determine the prevalence of exposure to SHS among those with and without stroke and its impact on mortality.
Methods—
Data were obtained from the US National Health and Nutrition Examination Surveys for 27 836 never smokers with/without self-reported stroke aged ≥18 years, sampled from 1988 to 1994 and 1999 to 2012, with linked mortality through 2010. Household exposure to SHS was determined by self-report; exposure severity was quantified by serum cotinine level. Independent relationships between SHS and all-cause mortality were assessed using Cox regression models, before and after adjusting for sociodemographics and comorbidities.
Results—
From 1988 to 1994 to 1999 to 2012, age-adjusted prevalence of exposure to SHS declined from 11.5% to 6.6% among survivors of stroke (
P
=0.08), and 14.6% to 5.9% among persons without stroke (
P
<0.01). Factors associated with high exposure to SHS were male sex, black race, ≤12th-grade education, poverty income ratio ≤200%, high alcohol intake, and history of myocardial infarction (all
P
<0.05). High exposure to SHS was associated with higher odds of previous stroke (odds ratio, 1.46;
P
=0.026). There was a dose-dependent relationship between exposure to SHS and all-cause mortality after stroke.
Conclusions—
Individuals with previous stroke have 50% greater odds to have been exposed to SHS; SHS is associated with a 2-fold increase in mortality after stroke. This study highlights the importance of obtaining exposure to SHS history and counseling patients and their families on the potential impact of SHS on poststroke outcomes.
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Affiliation(s)
- Michelle P. Lin
- From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (M.P.L.); Department of Neurology, Medical University of South Carolina, Charleston (B.O.); Department of Biomathematics, University of California at Los Angeles (D.M.); Department of Neurology, University of Southern California (A.T.); and Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.)
| | - Bruce Ovbiagele
- From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (M.P.L.); Department of Neurology, Medical University of South Carolina, Charleston (B.O.); Department of Biomathematics, University of California at Los Angeles (D.M.); Department of Neurology, University of Southern California (A.T.); and Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.)
| | - Daniela Markovic
- From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (M.P.L.); Department of Neurology, Medical University of South Carolina, Charleston (B.O.); Department of Biomathematics, University of California at Los Angeles (D.M.); Department of Neurology, University of Southern California (A.T.); and Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.)
| | - Amytis Towfighi
- From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (M.P.L.); Department of Neurology, Medical University of South Carolina, Charleston (B.O.); Department of Biomathematics, University of California at Los Angeles (D.M.); Department of Neurology, University of Southern California (A.T.); and Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.)
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Lee PN, Thornton AJ, Forey BA, Hamling JS. Environmental Tobacco Smoke Exposure and Risk of Stroke in Never Smokers: An Updated Review with Meta-Analysis. J Stroke Cerebrovasc Dis 2016; 26:204-216. [PMID: 27765554 DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/09/2016] [Accepted: 09/12/2016] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The study aimed to review the epidemiological evidence relating environmental tobacco smoke exposure to stroke in never smokers. METHODS The study is similar to our review in 2006, with searches extended to March 2016. RESULTS Twelve further studies were identified. A total of 28 studies varied considerably in design, exposure indices used, and disease definition. Based on 39 sex-specific estimates and the exposure index current spousal exposure (or nearest equivalent), the meta-analysis gave an overall fixed-effect relative risk estimate of 1.23 (95% confidence interval: 1.16-1.31), with significant (P < .05) heterogeneity. There was no significant heterogeneity by sex, continent, fatality, disease end point, or degree of adjustment for potential confounding factors. Relative risks were less elevated in prospective studies (1.15, 1.06-1.24) than in case-control studies (1.44, 1.22-1.60) or cross-sectional studies (1.40, 1.21-1.61). They also varied by publication year, but with no trend. A significant increase was not seen in studies that excluded smokers of any tobacco (1.07, .97-1.17), but was seen for studies that included pipe- or cigar-only smokers, occasional smokers, or long-term former smokers. No elevation was seen for hemorrhagic stroke. Relative risk estimates were similar using ever rather than current exposure, or total rather than spousal exposure. Eleven studies provided dose-response estimates, the combined relative risk for the highest exposure level being 1.56 (1.37-1.79). Many studies have evident weaknesses, recall bias, and particularly publication bias being major concerns. CONCLUSIONS Although other reviewers inferred a causal relationship, we consider the evidence does not conclusively demonstrate this. We repeat our call for publication of data from existing large prospective studies.
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Affiliation(s)
- Peter N Lee
- PN Lee Statistics and Computing Ltd, Sutton, Surrey, United Kingdom.
| | | | - Barbara A Forey
- PN Lee Statistics and Computing Ltd, Sutton, Surrey, United Kingdom
| | - Jan S Hamling
- PN Lee Statistics and Computing Ltd, Sutton, Surrey, United Kingdom
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Abstract
PURPOSE OF REVIEW The purpose is to summarize recent evidence on lifestyle modifications and first or recurrent stroke risk. RECENT FINDINGS Weight reduction, low-risk diet, regular physical activity, smoking cessation, and low-to-moderate alcohol consumption may reduce stroke risk up to 50% or more, but level one evidence is still lacking for several interventions. Appropriate food ingredients can significantly decrease stroke risk as recently confirmed for Mediterranean diet. The optimal intensity and amount of physical exercise is still not well established before and after stroke, although modest levels of activity already show benefits. Passive smoking represents an important health hazard. The impact of tobacco withdrawal using e-cigarette is currently uncertain. Alcohol and stroke risk relation is probably J-shaped for ischaemic stroke and linear for intracranial haemorrhage. Coffee consumption is J-shaped for overall stroke. Several interventions have failed to show significant effects, including regular intake of 'healthy' forms of fatty acids, various vitamin supplements, and other antioxidants. Both individualized and public educational programmes are likely needed on a repetitive basis to induce and maintain a healthy lifestyle before or after a stroke.
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Health Impact Assessment for Second-Hand Smoke Exposure in Germany--Quantifying Estimates for Ischaemic Heart Diseases, COPD, and Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:198. [PMID: 26861366 PMCID: PMC4772218 DOI: 10.3390/ijerph13020198] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/21/2016] [Accepted: 02/03/2016] [Indexed: 12/22/2022]
Abstract
Evidence of the adverse health effects attributable to second-hand smoke (SHS) exposure is available. This study aims to quantify the impact of SHS exposure on ischaemic heart diseases (IHD), chronic obstructive pulmonary diseases (COPD), and stroke in Germany. Therefore, this study estimated and forecasted the morbidity for the three outcomes in the German population. Furthermore, a health impact assessment was performed using DYNAMO-HIA, which is a generic software tool applying a Markov model. Overall 687,254 IHD cases, 231,973 COPD cases, and 288,015 stroke cases were estimated to be attributable to SHS exposure in Germany for 2014. Under the assumption that the population prevalence of these diseases and the prevalence of SHS exposure remain constant, the total number of cases will increase due to demographic aging. Assuming a total eradication of SHS exposure beginning in 2014 leads to an estimated reduction of 50% in cases, compared to the reference scenario in 2040 for all three diseases. The results highlight the relevance of SHS exposure because it affects several chronic disease conditions and has a major impact on the population’s health. Therefore, public health campaigns to protect non-smokers are urgently needed.
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2015; 133:e38-360. [PMID: 26673558 DOI: 10.1161/cir.0000000000000350] [Citation(s) in RCA: 3744] [Impact Index Per Article: 416.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Fischer F, Kraemer A. Meta-analysis of the association between second-hand smoke exposure and ischaemic heart diseases, COPD and stroke. BMC Public Health 2015; 15:1202. [PMID: 26627181 PMCID: PMC4667413 DOI: 10.1186/s12889-015-2489-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 11/12/2015] [Indexed: 02/07/2023] Open
Abstract
Background Second-hand smoke (SHS) is the most important contaminant of indoor air in first world countries. The risks associated with SHS exposure are highly relevant, because many people are regularly, and usually involuntarily, exposed to SHS. This study aims to quantify the effects of SHS exposure. Therefore, its impact on ischaemic heart diseases (IHD), chronic obstructive pulmonary diseases (COPD) and stroke will be considered. Methods A systematic literature review was conducted to identify articles dealing with the association between SHS and the three outcomes IHD, COPD and stroke. Overall, 24 articles were included in a meta-analysis using a random effects model. Effect sizes stratified for sex and for both sexes combined were calculated. Results The synthesis of primary studies revealed significant effect sizes for the association between SHS exposure and all three outcomes. The highest RR for both sexes combined was found for COPD (RR = 1.66, 95 % CI: 1.38–2.00). The RR for both sexes combined was 1.35 (95 % CI: 1.22–1.50) for stroke and 1.27 (95 % CI: 1.10–1.48) for IHD. The risks were higher in women than in men for all three outcomes. Conclusions This is the first study to calculate effect sizes for the association between SHS exposure and the disease outcomes IHD, COPD, and stroke at once. Overall, the effect sizes are comparable with previous findings in meta-analyses and therefore assumed to be reliable. The results indicate the high relevance of public health campaigns and legislation to protect non-smokers from the adverse health effects attributable to SHS exposure. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2489-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Florian Fischer
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, P.O. Box 100 131, 33501, Bielefeld, Germany.
| | - Alexander Kraemer
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, P.O. Box 100 131, 33501, Bielefeld, Germany.
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Galán I, Simón L, Flores V, Ortiz C, Fernández-Cuenca R, Linares C, Boldo E, José Medrano M, Pastor-Barriuso R. Assessing the effects of the Spanish partial smoking ban on cardiovascular and respiratory diseases: methodological issues. BMJ Open 2015; 5:e008892. [PMID: 26628524 PMCID: PMC4679921 DOI: 10.1136/bmjopen-2015-008892] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Recent research has assessed the impact of tobacco laws on cardiovascular and respiratory morbidity. In this study, we also examined whether the association between the implementation of the 2005 Spanish smoking ban and hospital admissions for cardiovascular and respiratory diseases varies according to the adjustment for potential confounders. DESIGN Ecological time series analysis. SETTING Residents of Madrid and Barcelona cities (Spain). OUTCOME Data on daily emergency room admissions for acute myocardial infarction, cerebrovascular disease, chronic obstructive pulmonary disease (COPD), and asthma derived from the 2003-2006 Spanish hospital admissions registry. METHODS Changes in admission rates between 2006 and the 2003-2005 period were estimated using additive Poisson models allowing for overdispersion adjusted for secular trend in admission, seasonality, day of the week, temperature, number of flu and acute respiratory infection cases, pollution levels, tobacco consumption prevalence and, for asthma cases, pollen count. RESULTS In Madrid, fully adjusted models failed to detect significant changes in hospital admission rates for any disease during the study period. In Barcelona, however, hospital admissions decreased by 10.2% (95% CI 3.8% to 16.1%) for cerebrovascular diseases and by 16.0% (95% CI 7.0% to 24.1%) for COPD. Substantial changes in effect estimates were observed on adjustment for linear or quadratic trend. Effect estimates for asthma-related admissions varied substantially when adjusting for pollen count in Madrid, and for seasonality and tobacco consumption in Barcelona. CONCLUSIONS Our results confirm that the potential impact of a smoking ban must be adjusted for the underlying secular trend. In asthma-related admissions, pollen count, seasonality and tobacco consumption must be specified in the model. The substantial variability in effects detected between the two cities of Madrid and Barcelona lends strong support for a nationwide study to assess the overall effect of a smoking ban in Spain and identify the causes of the observed heterogeneity.
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Affiliation(s)
- Iñaki Galán
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ, Madrid, Spain
| | - Lorena Simón
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Víctor Flores
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Ortiz
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael Fernández-Cuenca
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Cristina Linares
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Boldo
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Puerta de Hierro Biomedical Research Institute, Madrid, Spain
| | - María José Medrano
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Roberto Pastor-Barriuso
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Malek AM, Cushman M, Lackland DT, Howard G, McClure LA. Secondhand Smoke Exposure and Stroke: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Prev Med 2015; 49:e89-97. [PMID: 26117341 PMCID: PMC4656115 DOI: 10.1016/j.amepre.2015.04.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/30/2015] [Accepted: 04/21/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Stroke is a major public health concern worldwide given the associated morbidity and mortality. Smoking is a risk factor for stroke, but the relationship between secondhand smoke (SHS) exposure and stroke has been inconsistent to date. The aim of the current study was to examine the association of SHS exposure and risk of stroke and its subtypes (ischemic and hemorrhagic stroke) among nonsmokers. METHODS Demographic and clinical characteristics were compared by SHS exposure status for African American and white nonsmokers aged ≥45 years in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study in 2014. Hazard ratios (HRs) and corresponding 95% CIs were calculated by Cox proportional hazards models to assess the relationship between SHS exposure and stroke risk. RESULTS Of the 21,743 participants (38% African American, 45% male), SHS exposure in the past year was reported by 23%. Compared with those without SHS exposure, exposed participants were more likely to be female, white, younger, and reside with a smoker (all p<0.001). A total of 428 incident strokes were observed from April 2003 to March 2012 during a mean follow-up of 5.6 years. The risk of overall stroke was increased 30% among those with SHS exposure after adjustment for other stroke risk factors (95% CI=2%, 67%). This relationship appeared to be driven by ischemic strokes. CONCLUSIONS SHS exposure is independently associated with an increased risk of stroke. Future studies are needed to confirm these findings and examine the role of long-term effects of SHS exposure on stroke outcomes.
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Affiliation(s)
- Angela M Malek
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.
| | - Mary Cushman
- Departments of Medicine and Pathology, University of Vermont, Colchester, Vermont
| | - Daniel T Lackland
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Leslie A McClure
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
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Cao S, Yang C, Gan Y, Lu Z. The Health Effects of Passive Smoking: An Overview of Systematic Reviews Based on Observational Epidemiological Evidence. PLoS One 2015; 10:e0139907. [PMID: 26440943 PMCID: PMC4595077 DOI: 10.1371/journal.pone.0139907] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 09/19/2015] [Indexed: 12/16/2022] Open
Abstract
Purpose We aim to systematically summarize the available epidemiological evidence to identify the impact of environmental tobacco smoke on health. Methods A systematic literature search of PubMed, Embase, Web of Science, and Scopus for meta-analyses was conducted through January 2015. We included systematic reviews that investigated the association between passive smoking and certain diseases. Quantitative outcomes of association between passive smoking and the risk of certain diseases were summarized. Results Sixteen meta-analyses covering 130 cohort studies, 159 case-control studies, and 161 cross-sectional studies and involving 25 diseases or health problems were reviewed. Passive smoking appears not to be significantly associated with eight diseases or health problems, but significantly elevates the risk for eleven specific diseases or health problems, including invasive meningococcal disease in children (OR 2.18; 95% CI 1.63–2.92), cervical cancer (OR 1.73; 95% CI 1.35–2.21), Neisseria meningitidis carriage (OR 1.68; 95% CI 1.19–2.36), Streptococcus pneumoniae carriage (OR 1.66; 95% CI 1.33–2.07), lower respiratory infections in infancy (OR 1.42; 95% CI 1.33–1.51), food allergy (OR 1.43; 95% CI 1.12–1.83), and so on. Conclusions Our overview of systematic reviews of observational epidemiological evidence suggests that passive smoking is significantly associated with an increasing risk of many diseases or health problems, especially diseases in children and cancers.
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Affiliation(s)
- Shiyi Cao
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chen Yang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Gan
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zuxun Lu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail:
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Lv X, Sun J, Bi Y, Xu M, Lu J, Zhao L, Xu Y. Risk of all-cause mortality and cardiovascular disease associated with secondhand smoke exposure: a systematic review and meta-analysis. Int J Cardiol 2015; 199:106-15. [PMID: 26188829 DOI: 10.1016/j.ijcard.2015.07.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 05/13/2015] [Accepted: 07/03/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Emerging studies have assessed the association between secondhand smoke (SHS) exposure and cardiovascular disease (CVD) as well as all-cause mortality. However, findings were not consistent due to the heterogeneity of study characteristics. METHODS PubMed and Embase were searched through May 2014 for prospective cohort and case-control studies investigating the associations of SHS exposure in never smokers with all-cause mortality and the risk of CVD. The main analysis was performed in studies using self-reported SHS exposure and secondary analysis was performed in studies using objectively measured SHS exposure. Summary estimates were calculated using random-effects models. RESULTS Twenty-three prospective and 17 case-control studies were included. The pooled relative risks (RR) for never smokers exposed to SHS in comparison with those unexposed were 1.18 [95% confidence interval (CI): 1.10-1.27] for all-cause mortality (12 studies), and 1.23 (1.16-1.31) for CVD (38 studies). The association of SHS exposure with CVD was markedly stronger among studies conducted in China (RR=1.65, 95% CI 1.27-2.13) than that in the US (RR=1.09, 95% CI 1.03-1.16). Studies using objectively measured SHS exposure demonstrated a slightly higher risk for CVD compared with those using self-reported SHS exposure. CONCLUSIONS Exposure to SHS significantly increased the risk for all-cause mortality and CVD. The risk associated with SHS exposure was large in China while the risk was only modest in the US. Studies using objectively measured SHS exposure may yield a higher risk of CVD than those using self-reported SHS exposure.
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Affiliation(s)
- Xiaofei Lv
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, National Clinical Research Center for Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Jichao Sun
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, National Clinical Research Center for Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China; Laboratory of Endocrine and Metabolic Diseases, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, and Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Yufang Bi
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, National Clinical Research Center for Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Min Xu
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, National Clinical Research Center for Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Jieli Lu
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, National Clinical Research Center for Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Liebin Zhao
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, National Clinical Research Center for Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Yu Xu
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, National Clinical Research Center for Metabolic Diseases, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China.
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation 2014; 131:e29-322. [PMID: 25520374 DOI: 10.1161/cir.0000000000000152] [Citation(s) in RCA: 4464] [Impact Index Per Article: 446.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Nishino Y, Tsuji I, Tanaka H, Nakayama T, Nakatsuka H, Ito H, Suzuki T, Katanoda K, Sobue T, Tominaga S. Stroke mortality associated with environmental tobacco smoke among never-smoking Japanese women: a prospective cohort study. Prev Med 2014; 67:41-5. [PMID: 24983889 DOI: 10.1016/j.ypmed.2014.06.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 06/19/2014] [Accepted: 06/22/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study examined the association of exposure to environmental tobacco smoke (ETS) during adulthood with stroke and its subtypes using data from a large-scale prospective cohort study in Japan. METHODS The study population included 36,021 never-smoking Japanese women who were enrolled between 1983 and 1985 and were followed-up for 15 years. We used Cox proportional hazard regression models to estimate hazard ratios (HRs) for stroke death associated with ETS exposure at home during adulthood. RESULTS A total of 906 cases of stroke death were observed during 437,715 person-years of follow-up. Compared with never-smoking women without smoking family members, HRs for stroke mortality among never-smoking women living with smoking family members in all subjects, in those aged 40-79 years, and in those aged ≥ 80 years were 1.14 (95% confidence interval: 0.99-1.31), 1.24 (95% CI: 1.05-1.46), and 0.89 (95% CI: 0.66-1.19), respectively, after adjustment for possible confounders. The risk was most evident for subarachnoid hemorrhage [HR: 1.66 (95% CI: 1.02-2.70) in all subjects]. CONCLUSION This study suggests that exposure to ETS at home during adulthood is associated with an increased risk of stroke among never-smoking Japanese women.
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Affiliation(s)
- Yoshikazu Nishino
- Division of Cancer Epidemiology and Prevention, Miyagi Cancer Center Research Institute, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi 981-1293, Japan.
| | - Ichiro Tsuji
- Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Hideo Tanaka
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi 464-8681, Japan
| | - Tomio Nakayama
- Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan
| | - Haruo Nakatsuka
- School of Nursing, Miyagi University, 1 Gakuen, Taiwa, Kurokawa-gun, Miyagi 981-3298, Japan
| | - Hidemi Ito
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi 464-8681, Japan
| | - Takaichiro Suzuki
- Center for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan
| | - Kota Katanoda
- Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Tomotaka Sobue
- Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Suketami Tominaga
- Aichi Cancer Center, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi 464-8681, Japan
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Saleheen D, Zhao W, Rasheed A. Epidemiology and public health policy of tobacco use and cardiovascular disorders in low- and middle-income countries. Arterioscler Thromb Vasc Biol 2014; 34:1811-9. [PMID: 25035346 DOI: 10.1161/atvbaha.114.303826] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
All forms of tobacco lead to an increased risk of cardiovascular disorders. During the past few decades, the number of people who consume tobacco has increased worldwide because of an overall increase in the global population. It is estimated that close to 80% of the >1.3 billion people who smoke tobacco in the world are in low- and middle-income countries. Smokeless forms of tobacco are also widely consumed in low- and middle-income countries, including chewable and snuffed forms. Lack of targeted and effective strategies to control tobacco consumption contributes to a large burden of cardiovascular disorders in low- and middle-income countries, where cardiovascular disorders have become the leading cause of morbidity and mortality. In this review, we evaluate the epidemiology of tobacco use in low- and middle-income countries and assess the public health policies needed to control tobacco use in such regions for the prevention of cardiovascular disorders and other tobacco-related morbidities and mortality.
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Affiliation(s)
- Danish Saleheen
- From the Department of Biostatistics and Epidemiology (D.S.) and Division of Translational Medicine and Human Genetics, Perelman School of Medicine (D.S., W.Z.), University of Pennsylvania, Philadelphia; and Center for Non-Communicable Diseases, Karachi, Pakistan (D.S., A.R.).
| | - Wei Zhao
- From the Department of Biostatistics and Epidemiology (D.S.) and Division of Translational Medicine and Human Genetics, Perelman School of Medicine (D.S., W.Z.), University of Pennsylvania, Philadelphia; and Center for Non-Communicable Diseases, Karachi, Pakistan (D.S., A.R.)
| | - Asif Rasheed
- From the Department of Biostatistics and Epidemiology (D.S.) and Division of Translational Medicine and Human Genetics, Perelman School of Medicine (D.S., W.Z.), University of Pennsylvania, Philadelphia; and Center for Non-Communicable Diseases, Karachi, Pakistan (D.S., A.R.)
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71
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Heo S, Lee JT. Disease burdens from environmental tobacco smoke in Korean adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2014; 25:330-348. [PMID: 25155457 DOI: 10.1080/09603123.2014.945513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this study, we estimated the disease burdens attributable to environmental tobacco smoke (ETS) exposure in Korean adults in 2010 and analyzed the trend of that from 2005 to 2010. We obtained information on the study population from the 2010 Cause of Death Statistic and estimated the ETS-attributable fraction using data from the Korean Community Health Survey and the Korean National Health and Nutrition Examination Survey. The numbers of ETS-attributable deaths in female and male non-smokers were estimated to be 4.1 and 69.6% of the numbers of deaths attributable to current smoke, respectively. The deaths attributable to ETS were larger in female than in male non-smokers (710 vs. 420). The ETS-attributable deaths increased slightly in 2005-2008 but decreased in 2009-2010. The number of potential years of life lost from ETS was 9077.24 years in 2010. If there were no exposure to ETS in adult non-smokers, we would expect to see 1130 fewer deaths (9.9% of the deaths from current smoke). The results suggest that ETS poses considerable disease burdens for non-smokers, especially women, in Korea.
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Affiliation(s)
- Seulkee Heo
- a Department of Public Health Science , Graduate School, Korea University , Seoul , Republic of Korea
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Stallings-Smith S, Goodman P, Kabir Z, Clancy L, Zeka A. Socioeconomic differentials in the immediate mortality effects of the national Irish smoking ban. PLoS One 2014; 9:e98617. [PMID: 24887027 PMCID: PMC4041857 DOI: 10.1371/journal.pone.0098617] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 05/06/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Consistent evidence has demonstrated that smoking ban policies save lives, but impacts on health inequalities are uncertain as few studies have assessed post-ban effects by socioeconomic status (SES) and findings have been inconsistent. The aim of this study was to assess the effects of the national Irish smoking ban on ischemic heart disease (IHD), stroke, and chronic obstructive pulmonary disease (COPD) mortality by discrete and composite SES indicators to determine impacts on inequalities. METHODS Census data were used to assign frequencies of structural and material SES indicators to 34 local authorities across Ireland with a 2000-2010 study period. Discrete indicators were jointly analysed through principal component analysis to generate a composite index, with sensitivity analyses conducted by varying the included indicators. Poisson regression with interrupted time-series analysis was conducted to examine monthly age and gender-standardised mortality rates in the Irish population, ages ≥35 years, stratified by tertiles of SES indicators. All models were adjusted for time trend, season, influenza, and smoking prevalence. RESULTS Post-ban mortality reductions by structural SES indicators were concentrated in the most deprived tertile for all causes of death, while reductions by material SES indicators were more equitable across SES tertiles. The composite indices mirrored the results of the discrete indicators, demonstrating that post-ban mortality decreases were either greater or similar in the most deprived when compared to the least deprived for all causes of death. CONCLUSIONS Overall findings indicated that the national Irish smoking ban reduced inequalities in smoking-related mortality. Due to the higher rates of smoking-related mortality in the most deprived group, even equitable reductions across SES tertiles resulted in decreases in inequalities. The choice of SES indicator was influential in the measurement of effects, underscoring that a differentiated analytical approach aided in understanding the complexities in which structural and material factors influence mortality.
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Affiliation(s)
| | - Pat Goodman
- Environmental Health Sciences Institute, Dublin Institute of Technology, Dublin, Ireland
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | - Zubair Kabir
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Luke Clancy
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | - Ariana Zeka
- Institute for the Environment, Brunel University, London, United Kingdom
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Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, Fang MC, Fisher M, Furie KL, Heck DV, Johnston SCC, Kasner SE, Kittner SJ, Mitchell PH, Rich MW, Richardson D, Schwamm LH, Wilson JA. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:2160-236. [PMID: 24788967 DOI: 10.1161/str.0000000000000024] [Citation(s) in RCA: 2876] [Impact Index Per Article: 287.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.
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Burnett RT, Pope CA, Ezzati M, Olives C, Lim SS, Mehta S, Shin HH, Singh G, Hubbell B, Brauer M, Anderson HR, Smith KR, Balmes JR, Bruce NG, Kan H, Laden F, Prüss-Ustün A, Turner MC, Gapstur SM, Diver WR, Cohen A. An integrated risk function for estimating the global burden of disease attributable to ambient fine particulate matter exposure. ENVIRONMENTAL HEALTH PERSPECTIVES 2014; 122:397-403. [PMID: 24518036 PMCID: PMC3984213 DOI: 10.1289/ehp.1307049] [Citation(s) in RCA: 917] [Impact Index Per Article: 91.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 02/07/2014] [Indexed: 05/07/2023]
Abstract
BACKGROUND Estimating the burden of disease attributable to long-term exposure to fine particulate matter (PM2.5) in ambient air requires knowledge of both the shape and magnitude of the relative risk (RR) function. However, adequate direct evidence to identify the shape of the mortality RR functions at the high ambient concentrations observed in many places in the world is lacking. OBJECTIVE We developed RR functions over the entire global exposure range for causes of mortality in adults: ischemic heart disease (IHD), cerebrovascular disease (stroke), chronic obstructive pulmonary disease (COPD), and lung cancer (LC). We also developed RR functions for the incidence of acute lower respiratory infection (ALRI) that can be used to estimate mortality and lost-years of healthy life in children < 5 years of age. METHODS We fit an integrated exposure-response (IER) model by integrating available RR information from studies of ambient air pollution (AAP), second hand tobacco smoke, household solid cooking fuel, and active smoking (AS). AS exposures were converted to estimated annual PM2.5 exposure equivalents using inhaled doses of particle mass. We derived population attributable fractions (PAFs) for every country based on estimated worldwide ambient PM2.5 concentrations. RESULTS The IER model was a superior predictor of RR compared with seven other forms previously used in burden assessments. The percent PAF attributable to AAP exposure varied among countries from 2 to 41 for IHD, 1 to 43 for stroke, < 1 to 21 for COPD, < 1 to 25 for LC, and < 1 to 38 for ALRI. CONCLUSIONS We developed a fine particulate mass-based RR model that covered the global range of exposure by integrating RR information from different combustion types that generate emissions of particulate matter. The model can be updated as new RR information becomes available.
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Humair JP, Garin N, Gerstel E, Carballo S, Carballo D, Keller PF, Guessous I. Acute respiratory and cardiovascular admissions after a public smoking ban in Geneva, Switzerland. PLoS One 2014; 9:e90417. [PMID: 24599156 PMCID: PMC3944023 DOI: 10.1371/journal.pone.0090417] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 01/30/2014] [Indexed: 11/18/2022] Open
Abstract
Background Many countries have introduced legislations for public smoking bans to reduce the harmful effects of exposure to tobacco smoke. Smoking bans cause significant reductions in admissions for acute coronary syndromes but their impact on respiratory diseases is unclear. In Geneva, Switzerland, two popular votes led to a stepwise implementation of a state smoking ban in public places, with a temporary suspension. This study evaluated the effect of this smoking ban on hospitalisations for acute respiratory and cardiovascular diseases. Methods This before and after intervention study was conducted at the University Hospitals of Geneva, Switzerland, across 4 periods with different smoking legislations. It included 5,345 patients with a first hospitalisation for acute coronary syndrome, ischemic stroke, acute exacerbation of chronic obstructive pulmonary disease, pneumonia and acute asthma. The main outcomes were the incidence rate ratios (IRR) of admissions for each diagnosis after the final ban compared to the pre-ban period and adjusted for age, gender, season, influenza epidemic and secular trend. Results Hospitalisations for acute exacerbation of chronic obstructive pulmonary disease significantly decreased over the 4 periods and were lowest after the final ban (IRR = 0.54 [95%CI: 0.42–0.68]). We observed a trend in reduced admissions for acute coronary syndromes (IRR = 0.90 [95%CI: 0.80–1.00]). Admissions for ischemic stroke, asthma and pneumonia did not significantly change. Conclusions A legislative smoking ban was followed by a strong decrease in hospitalisations for acute exacerbation of chronic obstructive pulmonary disease and a trend for reduced admissions for acute coronary syndrome. Smoking bans are likely to be very beneficial for patients with chronic obstructive pulmonary disease.
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Affiliation(s)
- Jean-Paul Humair
- Division of Primary Care Medicine, University Hospitals of Geneva, Geneva, Switzerland
- * E-mail:
| | - Nicolas Garin
- Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Division of Internal Medicine, Chablais Regional Hospital, Monthey, Switzerland
| | - Eric Gerstel
- Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Division of Ambulatory Care and Emergency Medicine, Clinique La Colline, Geneva, Switzerland
| | - Sebastian Carballo
- Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - David Carballo
- Division of Cardiology, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Idris Guessous
- Unit of Population Epidemiology, Division of Primary Care Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Community Prevention Unit, Lausanne University Hospital, Lausanne, Switzerland
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Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation 2014; 129:e28-e292. [PMID: 24352519 PMCID: PMC5408159 DOI: 10.1161/01.cir.0000441139.02102.80] [Citation(s) in RCA: 3534] [Impact Index Per Article: 353.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Lackland DT, Roccella EJ, Deutsch AF, Fornage M, George MG, Howard G, Kissela BM, Kittner SJ, Lichtman JH, Lisabeth LD, Schwamm LH, Smith EE, Towfighi A. Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association. Stroke 2014; 45:315-53. [PMID: 24309587 PMCID: PMC5995123 DOI: 10.1161/01.str.0000437068.30550.cf] [Citation(s) in RCA: 559] [Impact Index Per Article: 55.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Stroke mortality has been declining since the early 20th century. The reasons for this are not completely understood, although the decline is welcome. As a result of recent striking and more accelerated decreases in stroke mortality, stroke has fallen from the third to the fourth leading cause of death in the United States. This has prompted a detailed assessment of the factors associated with the change in stroke risk and mortality. This statement considers the evidence for factors that have contributed to the decline and how they can be used in the design of future interventions for this major public health burden. METHODS Writing group members were nominated by the committee chair and co-chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiological studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize evidence and to indicate gaps in current knowledge. All members of the writing group had the opportunity to comment on this document and approved the final version. The document underwent extensive American Heart Association internal peer review, Stroke Council leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. RESULTS The decline in stroke mortality over the past decades represents a major improvement in population health and is observed for both sexes and for all racial/ethnic and age groups. In addition to the overall impact on fewer lives lost to stroke, the major decline in stroke mortality seen among people <65 years of age represents a reduction in years of potential life lost. The decline in mortality results from reduced incidence of stroke and lower case-fatality rates. These significant improvements in stroke outcomes are concurrent with cardiovascular risk factor control interventions. Although it is difficult to calculate specific attributable risk estimates, efforts in hypertension control initiated in the 1970s appear to have had the most substantial influence on the accelerated decline in stroke mortality. Although implemented later, diabetes mellitus and dyslipidemia control and smoking cessation programs, particularly in combination with treatment of hypertension, also appear to have contributed to the decline in stroke mortality. The potential effects of telemedicine and stroke systems of care appear to be strong but have not been in place long enough to indicate their influence on the decline. Other factors had probable effects, but additional studies are needed to determine their contributions. CONCLUSIONS The decline in stroke mortality is real and represents a major public health and clinical medicine success story. The repositioning of stroke from third to fourth leading cause of death is the result of true mortality decline and not an increase in mortality from chronic lung disease, which is now the third leading cause of death in the United States. There is strong evidence that the decline can be attributed to a combination of interventions and programs based on scientific findings and implemented with the purpose of reducing stroke risks, the most likely being improved control of hypertension. Thus, research studies and the application of their findings in developing intervention programs have improved the health of the population. The continued application of aggressive evidence-based public health programs and clinical interventions is expected to result in further declines in stroke mortality.
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78
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Wang Y, Ji J, Liu YJ, Deng X, He QQ. Passive smoking and risk of type 2 diabetes: a meta-analysis of prospective cohort studies. PLoS One 2013; 8:e69915. [PMID: 23922856 PMCID: PMC3724674 DOI: 10.1371/journal.pone.0069915] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 06/13/2013] [Indexed: 01/11/2023] Open
Abstract
Backgrounds/Objective The prevalence of diabetes is increasing rapidly all over the world. However, studies on passive smoking and type 2 diabetes have not been systematically assessed. Therefore, we conducted a meta-analysis to explore whether an association exists between passive smoking and risk of type 2 diabetes. Methods We searched PubMed, EMBASE, Cochrane library and Web of Science up to April 9th, 2013, to identify prospective cohort studies that assessed passive smoking and risk of type 2 diabetes. The fixed-effect model was used to calculate the overall relative risk (RR). Result 4 prospective cohort studies were included for analysis, with a total of 112,351 participants involved. The pooled RR was 1.28 (95% confidence interval (CI) 1.14 to 1.44) comparing those who were exposed to passive smoking with those who were not. Subgroup, sensitivity analysis and publication bias test suggested the overall result of this analysis was robust. Conclusions Passive smoking is associated with a significantly increased risk of type 2 diabetes. Further well-designed studies are warranted to confirm this association.
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Affiliation(s)
- Ying Wang
- School of Public Health, Wuhan University, Wuhan, P. R. China
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Jie Ji
- School of Public Health, Wuhan University, Wuhan, P. R. China
| | - Yu-jian Liu
- School of Public Health, Wuhan University, Wuhan, P. R. China
| | - Xuan Deng
- School of Public Health, Wuhan University, Wuhan, P. R. China
| | - Qi-qiang He
- School of Public Health, Wuhan University, Wuhan, P. R. China
- Global Health Institute, Wuhan University, Wuhan, P. R. China
- * E-mail:
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79
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Lu L, Mackay DF, Pell JP. Secondhand smoke exposure and intermittent claudication: a Scotland-wide study of 4231 non-smokers. Heart 2013; 99:1342-5. [PMID: 23872592 DOI: 10.1136/heartjnl-2013-304226] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Active smoking is an important risk factor for peripheral arterial disease. In contrast, published evidence on the association with secondhand smoke (SHS) is very limited. The aim of this study was to examine the association between SHS exposure and intermittent claudication (IC) among middle aged non-smokers. DESIGN Multivariate logistic regression analyses were used to adjust for potential confounders. SETTING The Scottish Health Survey, a pan-Scotland, representative survey of the general population. PATIENTS We conducted a cross-sectional study using the Scottish Health Surveys undertaken between 1998 and 2010. Inclusion was restricted to participants aged > 45 years. MAIN OUTCOME MEASURES Of the 4231 confirmed non-smokers (self-reported non-smokers with salivary cotinine concentrations < 15 ng/mL), 134 (3.2%) had IC based on the Edinburgh Claudication Questionnaire. RESULTS There was evidence of a dose relationship, whereby the risk of IC increased with increasing cotinine concentration. Following adjustment for potential confounders, participants with a cotinine concentration ≥ 2.7 ng/mL were still significantly more likely to have IC (OR 1.76, 95% CI 1.04 to 3.00; p = 0.036) compared with those with a cotinine concentration < 0.7 ng/mL. Among non-smokers, 5.6% (95% CI -0.8% to 11.7%) of cases of IC were attributable to cotinine concentrations ≥ 2.7 ng/mL and a further 3.6% (95% CI -6.6% to 12.8%) to cotinine concentrations of 0.7-2.6 ng/mL. CONCLUSIONS As with coronary heart disease and stroke, SHS exposure was independently associated with IC. Our findings add to the published evidence in support of protecting the general public from SHS exposure.
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Affiliation(s)
- Liya Lu
- Department of Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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80
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Stallings-Smith S, Zeka A, Goodman P, Kabir Z, Clancy L. Reductions in cardiovascular, cerebrovascular, and respiratory mortality following the national irish smoking ban: interrupted time-series analysis. PLoS One 2013; 8:e62063. [PMID: 23637964 PMCID: PMC3634756 DOI: 10.1371/journal.pone.0062063] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 03/17/2013] [Indexed: 12/02/2022] Open
Abstract
Background Previous studies have shown decreases in cardiovascular mortality following the implementation of comprehensive smoking bans. It is not known whether cerebrovascular or respiratory mortality decreases post-ban. On March 29, 2004, the Republic of Ireland became the first country in the world to implement a national workplace smoking ban. The aim of this study was to assess the effect of this policy on all-cause and cause-specific, non-trauma mortality. Methods A time-series epidemiologic assessment was conducted, utilizing Poisson regression to examine weekly age and gender-standardized rates for 215,878 non-trauma deaths in the Irish population, ages ≥35 years. The study period was from January 1, 2000, to December 31, 2007, with a post-ban follow-up of 3.75 years. All models were adjusted for time trend, season, influenza, and smoking prevalence. Results Following ban implementation, an immediate 13% decrease in all-cause mortality (RR: 0.87; 95% CI: 0.76–0.99), a 26% reduction in ischemic heart disease (IHD) (RR: 0.74; 95% CI: 0.63–0.88), a 32% reduction in stroke (RR: 0.68; 95% CI: 0.54–0.85), and a 38% reduction in chronic obstructive pulmonary disease (COPD) (RR: 0.62; 95% CI: 0.46–0.83) mortality was observed. Post-ban reductions in IHD, stroke, and COPD mortalities were seen in ages ≥65 years, but not in ages 35–64 years. COPD mortality reductions were found only in females (RR: 0.47; 95% CI: 0.32–0.70). Post-ban annual trend reductions were not detected for any smoking-related causes of death. Unadjusted estimates indicate that 3,726 (95% CI: 2,305–4,629) smoking-related deaths were likely prevented post-ban. Mortality decreases were primarily due to reductions in passive smoking. Conclusions The national Irish smoking ban was associated with immediate reductions in early mortality. Importantly, post-ban risk differences did not change with a longer follow-up period. This study corroborates previous evidence for cardiovascular causes, and is the first to demonstrate reductions in cerebrovascular and respiratory causes.
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Affiliation(s)
- Sericea Stallings-Smith
- Institute for the Environment, Brunel University, London, United Kingdom
- * E-mail: (SSS); (AZ)
| | - Ariana Zeka
- Institute for the Environment, Brunel University, London, United Kingdom
- * E-mail: (SSS); (AZ)
| | - Pat Goodman
- Environmental Health Sciences Institute, Dublin Institute of Technology, Dublin, Ireland
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | - Zubair Kabir
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Luke Clancy
- TobaccoFree Research Institute Ireland, Dublin, Ireland
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81
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Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Heart disease and stroke statistics--2013 update: a report from the American Heart Association. Circulation 2013; 127:e6-e245. [PMID: 23239837 PMCID: PMC5408511 DOI: 10.1161/cir.0b013e31828124ad] [Citation(s) in RCA: 3357] [Impact Index Per Article: 305.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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82
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Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, Amann M, Anderson HR, Andrews KG, Aryee M, Atkinson C, Bacchus LJ, Bahalim AN, Balakrishnan K, Balmes J, Barker-Collo S, Baxter A, Bell ML, Blore JD, Blyth F, Bonner C, Borges G, Bourne R, Boussinesq M, Brauer M, Brooks P, Bruce NG, Brunekreef B, Bryan-Hancock C, Bucello C, Buchbinder R, Bull F, Burnett RT, Byers TE, Calabria B, Carapetis J, Carnahan E, Chafe Z, Charlson F, Chen H, Chen JS, Cheng ATA, Child JC, Cohen A, Colson KE, Cowie BC, Darby S, Darling S, Davis A, Degenhardt L, Dentener F, Des Jarlais DC, Devries K, Dherani M, Ding EL, Dorsey ER, Driscoll T, Edmond K, Ali SE, Engell RE, Erwin PJ, Fahimi S, Falder G, Farzadfar F, Ferrari A, Finucane MM, Flaxman S, Fowkes FGR, Freedman G, Freeman MK, Gakidou E, Ghosh S, Giovannucci E, Gmel G, Graham K, Grainger R, Grant B, Gunnell D, Gutierrez HR, Hall W, Hoek HW, Hogan A, Hosgood HD, Hoy D, Hu H, Hubbell BJ, Hutchings SJ, Ibeanusi SE, Jacklyn GL, Jasrasaria R, Jonas JB, Kan H, Kanis JA, Kassebaum N, Kawakami N, Khang YH, Khatibzadeh S, Khoo JP, Kok C, Laden F, Lalloo R, Lan Q, Lathlean T, Leasher JL, Leigh J, Li Y, Lin JK, Lipshultz SE, London S, Lozano R, Lu Y, Mak J, Malekzadeh R, Mallinger L, Marcenes W, March L, Marks R, Martin R, McGale P, McGrath J, Mehta S, Mensah GA, Merriman TR, Micha R, Michaud C, Mishra V, Mohd Hanafiah K, Mokdad AA, Morawska L, Mozaffarian D, Murphy T, Naghavi M, Neal B, Nelson PK, Nolla JM, Norman R, Olives C, Omer SB, Orchard J, Osborne R, Ostro B, Page A, Pandey KD, Parry CDH, Passmore E, Patra J, Pearce N, Pelizzari PM, Petzold M, Phillips MR, Pope D, Pope CA, Powles J, Rao M, Razavi H, Rehfuess EA, Rehm JT, Ritz B, Rivara FP, Roberts T, Robinson C, Rodriguez-Portales JA, Romieu I, Room R, Rosenfeld LC, Roy A, Rushton L, Salomon JA, Sampson U, Sanchez-Riera L, Sanman E, Sapkota A, Seedat S, Shi P, Shield K, Shivakoti R, Singh GM, Sleet DA, Smith E, Smith KR, Stapelberg NJC, Steenland K, Stöckl H, Stovner LJ, Straif K, Straney L, Thurston GD, Tran JH, Van Dingenen R, van Donkelaar A, Veerman JL, Vijayakumar L, Weintraub R, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams W, Wilson N, Woolf AD, Yip P, Zielinski JM, Lopez AD, Murray CJL, Ezzati M, AlMazroa MA, Memish ZA. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380:2224-60. [PMID: 23245609 PMCID: PMC4156511 DOI: 10.1016/s0140-6736(12)61766-8] [Citation(s) in RCA: 7253] [Impact Index Per Article: 604.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. METHODS We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. FINDINGS In 2010, the three leading risk factors for global disease burden were high blood pressure (7·0% [95% uncertainty interval 6·2-7·7] of global DALYs), tobacco smoking including second-hand smoke (6·3% [5·5-7·0]), and alcohol use (5·5% [5·0-5·9]). In 1990, the leading risks were childhood underweight (7·9% [6·8-9·4]), household air pollution from solid fuels (HAP; 7·0% [5·6-8·3]), and tobacco smoking including second-hand smoke (6·1% [5·4-6·8]). Dietary risk factors and physical inactivity collectively accounted for 10·0% (95% UI 9·2-10·8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water and sanitation accounting for 0·9% (0·4-1·6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. INTERPRETATION Worldwide, the contribution of different risk factors to disease burden has changed substantially, with a shift away from risks for communicable diseases in children towards those for non-communicable diseases in adults. These changes are related to the ageing population, decreased mortality among children younger than 5 years, changes in cause-of-death composition, and changes in risk factor exposures. New evidence has led to changes in the magnitude of key risks including unimproved water and sanitation, vitamin A and zinc deficiencies, and ambient particulate matter pollution. The extent to which the epidemiological shift has occurred and what the leading risks currently are varies greatly across regions. In much of sub-Saharan Africa, the leading risks are still those associated with poverty and those that affect children. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Stephen S Lim
- Institute for Health Metrics and Evaluation, Seattle, WA 98121, USA.
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Tan CE, Glantz SA. Association between smoke-free legislation and hospitalizations for cardiac, cerebrovascular, and respiratory diseases: a meta-analysis. Circulation 2012; 126:2177-83. [PMID: 23109514 PMCID: PMC3501404 DOI: 10.1161/circulationaha.112.121301] [Citation(s) in RCA: 215] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Secondhand smoke causes cardiovascular and respiratory disease. Smoke-free legislation is associated with a lower risk of hospitalization and death from these diseases. METHODS AND RESULTS Random-effects meta-analysis was conducted by law comprehensiveness to determine the relationship between smoke-free legislation and hospital admission or death from cardiac, cerebrovascular, and respiratory diseases. Studies were identified by using a systematic search for studies published before November 30, 2011 with the use of the Science Citation Index, Google Scholar, PubMed, and Embase and references in identified articles. Change in hospital admissions (or deaths) in the presence of a smoke-free law, duration of follow-up, and law comprehensiveness (workplaces only; workplaces and restaurants; or workplaces, restaurants, and bars) were recorded. Forty-five studies of 33 smoke-free laws with median follow-up of 24 months (range, 2-57 months) were included. Comprehensive smoke-free legislation was associated with significantly lower rates of hospital admissions (or deaths) for all 4 diagnostic groups: coronary events (relative risk, 0.848; 95% confidence interval 0.816-0.881), other heart disease (relative risk, 0.610; 95% confidence interval, 0.440-0.847), cerebrovascular accidents (relative risk, 0.840; 95% confidence interval, 0.753-0.936), and respiratory disease (relative risk, 0.760; 95% confidence interval, 0.682-0.846). The difference in risk following comprehensive smoke-free laws does not change with longer follow-up. More comprehensive laws were associated with larger changes in risk. CONCLUSIONS Smoke-free legislation was associated with a lower risk of smoking-related cardiac, cerebrovascular, and respiratory diseases, with more comprehensive laws associated with greater changes in risk.
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Affiliation(s)
- Crystal E. Tan
- Center for Tobacco Control Research and Education, University of California, San Francisco
| | - Stanton A. Glantz
- Center for Tobacco Control Research and Education, University of California, San Francisco
- Department of Medicine, University of California, San Francisco
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84
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Smoke-free environments: age, sex, and educational disparity in 25 Argentinean cities. Cancer Causes Control 2012; 23:1607-14. [DOI: 10.1007/s10552-012-0038-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 07/19/2012] [Indexed: 10/28/2022]
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85
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Olasky SJ, Levy D, Moran A. Second hand smoke and cardiovascular disease in Low and Middle Income Countries: a case for action. Glob Heart 2012; 7:151-160.e5. [PMID: 23139915 DOI: 10.1016/j.gheart.2012.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Second hand tobacco smoke (SHS) is an environmental toxin and an established cause of cardiovascular disease in nonsmokers. Smoke free laws reduce SHS and its downstream cardiovascular disease, but until recently evidence to support smoke free law implementation in low and middle income country settings was limited. In 14 low and middle income nations surveyed by the Global Adult Tobacco Survey active smoking prevalence in adults (≥15 years old) was universally higher in males (range 21.6-60.2%) compared with females (0.5-24.4%), and the highest burden of SHS exposure was in women (strong positive association between male/female active smoking ratio and female SHS exposure prevalence). A systematic review was conducted of MEDLINE-indexed studies of self-reported SHS exposure and cardiovascular harms in low or middle income nations. Eight papers reported the association of SHS with ischemic heart disease and four reported the association of SHS with stroke. For all the studies, and almost all sources of SHS surveyed, a strong positive association between SHS and ischemic heart disease (main relative odds ratio range 1.17-2.36) and SHS and stroke (odds ratio or hazard ratio 1.41-1.49). Prevalence of SHS exposure is high in low and middle income nations, especially among women. Epidemiologic evidence supports the conclusion that SHS harms are the same across low, middle and high income nations. Governments have an obligation to protect citizens from SHS exposure, enforcing smoke-free legislation and providing public education about SHS harms.
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Affiliation(s)
- Sheera Joy Olasky
- Department of Sociology, New York University, New York, New York, United States of America
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Semple S, Garden C, Coggins M, Galea KS, Whelan P, Cowie H, Sánchez-Jiménez A, Thorne PS, Hurley JF, Ayres JG. Contribution of solid fuel, gas combustion, or tobacco smoke to indoor air pollutant concentrations in Irish and Scottish homes. INDOOR AIR 2012; 22:212-23. [PMID: 22007695 PMCID: PMC3573694 DOI: 10.1111/j.1600-0668.2011.00755.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
UNLABELLED There are limited data describing pollutant levels inside homes that burn solid fuel within developed country settings with most studies describing test conditions or the effect of interventions. This study recruited homes in Ireland and Scotland where open combustion processes take place. Open combustion was classified as coal, peat, or wood fuel burning, use of a gas cooker or stove, or where there is at least one resident smoker. Twenty-four-hour data on airborne concentrations of particulate matter<2.5 μm in size (PM2.5), carbon monoxide (CO), endotoxin in inhalable dust and carbon dioxide (CO2), together with 2-3 week averaged concentrations of nitrogen dioxide (NO2) were collected in 100 houses during the winter and spring of 2009-2010. The geometric mean of the 24-h time-weighted-average (TWA) PM2.5 concentration was highest in homes with resident smokers (99 μg/m3--much higher than the WHO 24-h guidance value of 25 μg/m3). Lower geometric mean 24-h TWA levels were found in homes that burned coal (7 μg/m3) or wood (6 μg/m3) and in homes with gas cookers (7 μg/m3). In peat-burning homes, the average 24-h PM2.5 level recorded was 11 μg/m3. Airborne endotoxin, CO, CO2, and NO2 concentrations were generally within indoor air quality guidance levels. PRACTICAL IMPLICATIONS Little is known about indoor air quality (IAQ) in homes that burn solid or fossil-derived fuels in economically developed countries. Recent legislative changes have moved to improve IAQ at work and in enclosed public places, but there remains a real need to begin the process of quantifying the health burden that arises from indoor air pollution within domestic environments. This study demonstrates that homes in Scotland and Ireland that burn solid fuels or gas for heating and cooking have concentrations of air pollutants generally within guideline levels. Homes where combustion of cigarettes takes place have much poorer air quality.
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Affiliation(s)
- S Semple
- Scottish Centre for Indoor Air, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
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