Impact of a partial smoke-free legislation on myocardial infarction incidence, mortality and case-fatality in a population-based registry: the REGICOR Study

PLoS One. 2013;8(1):e53722. doi: 10.1371/journal.pone.0053722. Epub 2013 Jan 23.


Background and objective: Coronary heart disease (CHD) is the leading cause of death, and smoking its strongest modifiable risk factor. Our aim was to determine the impact of the Spanish 2006 partial smoke-free legislation on acute myocardial infarction (AMI) incidence, hospitalization and mortality rates, and 28-day case-fatality in Girona, Spain.

Methods: Using a population-based registry (the REGICOR Study), we compared population incidence, hospitalization, and mortality rates, and 28-day case-fatality in the pre- and post-ban periods (2002-2005 and 2006-2008, respectively) by binomial regression analysis adjusted for confounding factors. We also analyzed the ban's impact on the outcomes of interest using the AMI definitions of the American Heart Association (AHA)/European Society of Cardiology (ESC) and the World Health Organization (WHO)-Monitoring trends and determinants in cardiovascular diseases (MONICA).

Results: In the post-ban period, AMI incidence and mortality rates significantly decreased (relative risk [RR] = 0.89; 95% confidence interval [CI] = 0.81-0.97 and RR = 0.82; 95% CI = 0.71-0.94, respectively). Incidence and mortality rates decreased in both sexes, especially in women, and in people aged 65-74 years. Former and non-smokers (passive smokers) showed diminished incidence rates. Implementation of the ban was not associated with AMI case-fatality. Models tended to be more significant with the WHO-MONICA than with the AHA/ESC definition.

Conclusions: The 2006 Spanish partial smoke-free legislation was associated with a decrease in population AMI incidence and mortality, particularly in women, in people aged 65-74 years, and in passive smokers. These results clarify the association between AMI mortality and the enactment of a partial smoke-free legislation and reinforce the effectiveness of smoking regulations in preventing CHD.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Coronary Disease / etiology
  • Coronary Disease / mortality*
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Myocardial Infarction / etiology
  • Myocardial Infarction / mortality*
  • Registries*
  • Regression Analysis
  • Risk Factors
  • Smoke / adverse effects*
  • Spain / epidemiology
  • Survival Analysis
  • Tobacco / adverse effects*
  • Tobacco Smoke Pollution / adverse effects*


  • Smoke
  • Tobacco Smoke Pollution

Grant support

This work has been supported by the Government of Spain through the Ministry of Science and Innovation, Carlos III Health Institute (Ministerio de Economía e Innovación, Instituto de Salud Carlos III/European Regional Development Found) [Red HERACLES RD06/0009], the Government of Catalunya through the Catalan Research and Technology Innovation Interdepartmental Commission (Consell Interdepartamental de Recerca i Innovació Tecnològica) [2009/SGR/1195]. Dr. Grau is supported by a research fellowship award from the Government of Spain through the Ministry of Science and Innovation, Carlos III Health Institute [CM08/00141]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.