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Decrease in mortality rate and hospital admissions for acute myocardial infarction after the enactment of the smoking ban law in São Paulo city, Brazil
  1. Tania M O Abe1,
  2. Jaqueline Scholz1,
  3. Eduardo de Masi2,
  4. Moacyr R C Nobre1,
  5. Roberto Kalil Filho1
  1. 1Medicine Faculty, Heart Institute, University of São Paulo, São Paulo, São Paulo, Brazil
  2. 2Municipal Health Secretary, Municipality of São Paulo, São Paulo, São Paulo, Brazil
  1. Correspondence to Tania M O Abe, Heart Institute, Medicine Faculty, University of São Paulo, Rua Dr Eneas de Carvalho Aguiar 44—1 andar Bloco 2–São Paulo, SP CEP 05403-000, Brazil; drataniaogawa{at}


Background Smoking restriction laws have spread worldwide during the last decade. Previous studies have shown a decline in the community rates of myocardial infarction after enactment of these laws. However, data are scarce about the Latin American population. In the first phase of this study, we reported the successful implementation of the law in São Paulo city, with a decrease in carbon monoxide rates in hospitality venues.

Objective To evaluate whether the 2009 implementation of a comprehensive smoking ban law in São Paulo city was associated with a reduction in rates of mortality and hospital admissions for myocardial infarction.

Methods We performed a time-series study of monthly rates of mortality and hospital admissions for acute myocardial infarction from January 2005 to December 2010. The data were derived from DATASUS, the primary public health information system available in Brazil and from Mortality Information System (SIM). Adjustments and analyses were performed using the Autoregressive Integrated Moving Average with exogenous variables (ARIMAX) method modelled by environmental variables and atmospheric pollutants to evaluate the effect of smoking ban law in mortality and hospital admission rate. We also used Interrupted Time Series Analysis (ITSA) to make a comparison between the period pre and post smoking ban law.

Results We observed a reduction in mortality rate (−11.9% in the first 17 months after the law) and in hospital admission rate (−5.4% in the first 3 months after the law) for myocardial infarction after the implementation of the smoking ban law.

Conclusions Hospital admissions and mortality rate for myocardial infarction were reduced in the first months after the comprehensive smoking ban law was implemented.

  • Secondhand smoke
  • Surveillance and monitoring
  • Public policy
  • Environment

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  • Correction notice This article has been corrected since it was published Online First. The values in the final column of Table 2 have been updated. Data concerning monthly number of deaths for myocardial infarction was provided by Health Ministry through Mortality Information System and DATASUS. During the registration of information in table 2, the last column mistakenly recorded the sum of the number of stroke deaths with the number of stroke and infarction added, that is, unreal numbers. The correct numbers are now shown. The information can be obtained in This information will not interfere with the rest of the analysis, because the analysis was done will the original data of deaths, not based in this table.

  • Contributors TMOA conducted the study and submitted the article. JS planned the study and reviewed the article. EdM made the statistical analysis and help in the article writing. MRCN and RKF planned the study.

  • Competing interests None declared.

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