December 25, 2012

Stanton A. Glantz, PhD

Smokefree laws linked to lower hospitalizations for heart attacks and lung disease among Medicare beneficiaries

Mark Vander Weg and colleagues at the University of Iowa just published a paper in Health Affairs that analyzes Medicare hospital admissions for the entire country from 1990 through 2008 and estimates how hospital admissions change following passage of smokefree workplace, restaurant and bar laws.  The found that risk-adjusted admission rates for acute myocardial infarction dropped 14-16 percent following implementation of new laws, with the effect growing with time.  They also found a drop of 5 percent for chronic obstructive pulmonary disease following the law, growing to 17 percent at 36 months.  

Confirming the meta-analysis Crystal Tan and I recently published in Circulation, they found a "dose-response" effect, with more comprehensive laws being followed by bigger drops in hospital admissions.

They also look at admission rates for gastrointestinal hemorrhage and hip fracture.  They found no relationship with GI hemorrhage and a modest effect on hip fracture. as one would expect based on the biology.

This is an important contribution to the literature because of its national scope and the fact that it shows rapid benefits for the Medicare population at a time that people are searching for ways to reduce Medicare costs.  It also reinforces the case that including exceptions in smokefree laws mean more hospital admissions.  Right now.

It also points to the need for the FDA to revise its economic analysis of the effect of tobacco control policies (including redoing its warning label analysis) to account for these immediate benefits.

The full citation for the paper is: Vander Weg M, Rosenthal GF, Sarrazin MV.  Smoking bans linked to lower hospitalizations for heart attacks and ling disease among Medicare beneficiaries.  Health Affairs 2012; 31(12): 2699-2707.  doi:10.1377/hithaff.2011.0385.

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