Clean Indoor Air Regulation and Incidence of Hospital Admissions for Acute Coronary Syndrome in Kanawha County, West Virginia

INTRODUCTION: Secondhand smoke is a risk factor for coronary heart disease. Laws and regulations prohibiting smoking in public areas and workplaces can reduce rates of acute myocardial infarction. Our objective was to describe hospital admission rates for acute coronary events, based on smoking status, diabetes status, and sex, in the presence of a long-standing (2000-2008) county clean indoor air regulation (CIAR). We also examined the effect of making restaurants completely smoke-free. METHODS: We obtained hospital admission data for acute coronary syndrome (ACS) and acute myocardial infarction from all acute care hospitals serving Kanawha County, West Virginia, for 2000 through 2008. A CIAR was enacted in 1995 and revised in 2000 and 2003. We performed descriptive analyses on hospital admission rates of ACS over time and present these data by sex, age group, smoking status, and medical history of diabetes. RESULTS: The incidence of hospital admissions for ACS consistently declined during the period studied. This change was most pronounced among nonsmokers, people without diabetes, and women, compared with their respective counterparts. Similar benefits occurred for male smokers when the CIAR was revised to make restaurants completely smoke-free in 2004. CONCLUSIONS: In the presence of a CIAR, a consistent decline in incidence of hospital admissions for ACS can be demonstrated. However, the benefits derived may be disproportionately affected by smoking status, diabetes status, and sex.