SINGAPORE: Research recently published in BMJ Global Health, an open-access journal, suggests that when Singapore extended the smoking ban in 2013 to communal areas of residential blocks and other outdoor spaces, it prevented as many as 20,000 heart attacks in individuals from the ages of 65 and older.
The study looked into the link between smoke-free laws implemented in outdoor and the common areas of residential blocks and reported heart attacks, or acute myocardial infarctions (AMI), in Singapore. The extension of the smoking ban was associated with a drop in heart attacks reported per month. The study showed that older people and men have benefited the most from the extension.
BMJ noted the researchers as saying that around 1.3 million deaths around the world every year are caused by exposure to second-hand smoke, with many of the deaths caused by heart attacks. The researchers added that the existing evidence on the health benefits of comprehensive smoke-free laws covers mostly smoking bans for indoor spaces instead of housing estates and outdoor spaces.
Smoke-free laws have been extended to all common spaces of housing blocks in Singapore since 2013, affecting 80 per cent of the population who live in this type of residence. The ban also covers outdoor spaces, including covered linkways, overhead bridges, and areas within 5 metres of bus stops. In 2016, parks were included in the smoking ban, and by the following year, all schools, buses, and taxis.
The research looked into data from the Singapore Myocardial Infarction Registry from January 2010 through to December 2019 in order to determine the effect of these laws on the rates of heart attacks. In these 10 years, 133,868 heart attacks occurred. Sixty-six per cent (87,763) of those who suffered AMIs were men and 60 per cent (80,597) were individuals aged 65 years and older.
However, before the laws were extended banning smoking in common outdoor spaces starting in 2013, the rate of AMI for the age group was around 10 times more than for younger individuals, and almost twice as many men than women suffered heart attacks.
Before 2013, the number of heart attacks increased by a rate of 0.9 per million people each month. However, this figure dropped to 0.6 per million afterwards. The researchers, therefore, suggest that 2097 additional AMIs could have occurred should the laws not been extended to cover common outdoor spaces.
Notably, the monthly decrease in AMI rates for people from the age of 65 and older was nearly 15 times more than for younger people, as seen by the following results 5.9 per million for the older cohort and 0.4 million for the younger, showing that 19,591 more heart attacks may have taken place among the older set, while 1,325 additional AMIs could have occurred among younger people. As for men, as many as 4748 heart attacks were possibly prevented.
Interestingly, after the additional extensions to the ban were implemented in 2016 and 2017 , these did not necessarily result in even fewer AMIs. This was “an unexpected study finding given that public smoke-free laws should reduce environmental smoke exposure in public places, and this should theoretically reduce the risk of smoke-induced [heart attack] cases.”
However, the researchers say that this could be explained due to the country’s ageing population as well as a new blood test used in hospitals to improve heart attack diagnosis.
Additionally, while the researchers note that the study is an observational one that may not be applicable in other places, they concluded that their study “provides additional evidence for policymakers who are considering expanding their smoke-free laws to reduce the adverse consequences of population exposure to tobacco smoke”.
The original research for the study may be found here.
/TISG