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Hospital admissions for acute myocardial infarction before and after implementation of a comprehensive smoke-free policy in Uruguay
  1. Ernesto Marcelo Sebrié1,
  2. Edgardo Sandoya2,
  3. Andrew Hyland1,
  4. Eduardo Bianco2,
  5. Stanton A Glantz3,
  6. K Michael Cummings4
  1. 1Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
  2. 2Centro de Investigación para la Epidemia del Tabaquismo, Montevideo, Uruguay, on behalf of Uruguay collaborators and participating hospitals (listed in appendix 1)
  3. 3Center for Tobacco Control Research and Education, Cardiovascular Research Institute, Department of Medicine, Division of Cardiology, University of California, San Francisco, California, USA
  4. 4Medical University of South Carolina, Psychiatry and Behavioral Sciences, Charleston, South Carolina, USA
  1. Correspondence to Ernesto Marcelo Sebrié, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263, USA; ernesto.sebrie{at}


Background Stimulated by the WHO Framework Convention on Tobacco Control, many countries in Latin America adopted comprehensive smoke-free policies. In March 2006, Uruguay became the first Latin American country to adopt 100% smoke-free national legislation, which ended smoking in all indoor public places and workplaces, including restaurants and bars. The objective of this study was to evaluate trends in hospital admissions for cardiovascular disease 2 years before and 2 years after the policy was implemented in Uruguay.

Methods Reports of hospital admissions for acute myocardial infarction (AMI) (International Classification of Disease-10 I21) from 37 hospitals (79% of all hospital admissions in the country), representing the period 2 years before and 2 years after the adoption of a nationwide smoke-free policy in Uruguay (between 1 March 2004 and 29 February 2008), were reviewed. A time series analysis was undertaken to compare the average monthly number of events of hospital admission for AMI before and after the smoke-free law.

Results A total of 7949 hospital admissions for AMI were identified during the 4-year study period. Two years after the smoke-free policy was enacted, hospital admissions for AMI fell by 22%. The same pattern and roughly the same magnitude of reduction in AMI admissions were observed for patients seen in public and private hospitals, men, women and people aged 40–65 years and older than 65 years.

Conclusions The national smoke-free policy implemented in Uruguay in 2006 was associated with a significant reduction in hospital admissions for AMI.

  • Tobacco industry, public opinion polls, environmental tobacco smoke, packaging and labelling, advocacy, smoking-caused disease, prevalence, taxation and price, harm reduction, cessation, economics, environment, advertising and promotion, litigation

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  • Funding This research was funded by the Flight Attendant Medical Research Institute and the program project grant P01 CA138389 ‘Effectiveness of Tobacco Control Policies in High vs. Low Income Countries’ to Roswell Park Cancer Institute. ES and EB received funding from grant number 104399-1 of the Institute for Development Research Centre of Canada and a subsidy for independent research WS353475 by Pfizer Foundation of the United States. SAG was supported by the US National Cancer Institute (grant CA-61021). The funding agencies played no role in the conduct of the research or preparation of the manuscript.

  • Competing interests None.

  • Ethics approval Ethics approval was approved by Office of Research Subject Protection at Roswell Park Cancer Institute in Buffalo, New York, and at the School of Medicine, University of the Republic in Montevideo, Uruguay.

  • Provenance and peer review Not commissioned; externally peer reviewed.