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The smoke-free legislation in Hong Kong: its impact on mortality
  1. Thuan-Quoc Thach,
  2. Sarah M McGhee,
  3. Jason C So,
  4. June Chau,
  5. Eric K P Chan,
  6. Chit-Ming Wong,
  7. Anthony J Hedley
  1. School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
  1. Correspondence to Dr Thuan-Quoc Thach, School of Public Health, The University of Hong Kong, 5/F William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong 852, Hong Kong; thach{at}


Objectives To examine trends in deaths for conditions associated with secondhand smoke exposure over the years prior to and following the implementation of a smoke-free policy in Hong Kong.

Design Time-series study.

Setting Death registration data from Hong Kong Special Administrative Region (SAR) Government Census and Statistics Department.

Participants All deaths registered from 1 January 2001 to 31 December 2011.

Main outcome measures Deaths for conditions associated with passive smoking include cardiovascular disease (CVD), respiratory disease and other causes.

Results There was a decline in the annual proportional change for ischaemic heart disease (IHD), acute myocardial infarction (AMI) and CVD mortality in the year after the intervention for all ages and those aged 65 years or older. There were also clear declines in the cool season peaks for these three conditions in the first postintervention year. There was a further drop in the cool season peak for AMI among all ages in the year after the exemptions ceased. No declines in annual proportional change or changes in seasonal peaks of mortality were found for any of the control conditions.

Conclusions The findings in this study add to the evidence base, as summarised in the Surgeon General's report, extending the impact of effective smoke-free legislation to those aged 65 years or older and to cerebrovascular events in younger age groups. They also reinforced the need for comprehensive, enforced and effective smoke-free laws if the full extent of the health gains are to be achieved.

  • Smoking Caused Disease
  • Public policy
  • Secondhand smoke

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  • Deceased 19 December 2014

  • Contributors TQT was responsible for the study design, advice for the data analysis, writing and critical review. SMG was responsible for the study design, data interpretation, writing and critical review. JCS was responsible for data collection, data analysis, data interpretation and writing. JC was responsible for data collection and writing; EKPC was responsible for statistical advice. CMW was responsible for the study design and advice for the data analysis. AJH was responsible for research questions, study design, data interpretation, writing and critical review.

  • Funding This study was funded by the Tobacco Control Office, Department of Health, the Hong Kong Special Administrative Region.

  • Competing interests None declared.

  • Ethics approval The study obtained ethics approval from the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (HKU/HA HKW IRB), IRB reference number UW 13-507.

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