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Duke-NUS Medical School study finds extension of smoking ban linked to monthly fall in heart attack cases

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Singapore’s smoke-free law in communal areas of residential blocks and outdoor spaces may have contributed to a monthly fall in heart attack cases.

Duke-NUS Medical School study is the first Singapore study investigating the effects of expanding the smoking ban law to communal areas of residential blocks and other outdoor spaces.

Existing evidence on the health benefits of comprehensive smoke-free laws, which many countries (67 since 2003) have implemented, is largely confined to indoor smoking bans rather than those for housing estates and outdoor spaces.

The study showed that the extension of the smoking ban was associated with a monthly fall in the rate of heart attacks, with older people and men benefitting the most.

This may have prevented up to 20,000 heart attacks among those aged 65 and above.

heart attack

In 2013, Singapore extended smoke-free legislation to all communal areas of residential blocks, as well as outdoor spaces, including covered linkways, overhead bridges and within 5 metres of bus stops. This was further extended to reservoirs and all residential parks in 2016, and to more educational institutions as well as more types of buses and taxis in 2017.

Before the 2013 extension, the rate of heart attacks among those aged 65 and above was around 10 times that of those under 65 years of age. The rate of cases among men was nearly double that of women. The overall number of heart attacks rose by a rate of 0.9 cases per million people every month before the 2013 extension. But afterwards, this rate fell to 0.6 cases per million people.

Seniors and men were the primary beneficiaries of the extended ban. The monthly fall in heart attack rate among those aged 65 and above was 5.9 cases per million people. This fall in the rate is almost 15 times greater than that in younger individuals, which stood at 0.4 cases per million people.

Smoking remains an unresolved epidemic in Asia, with majority of tobacco consumers being in the region. This study provides additional evidence for policy makers who are looking to expand their smoke-free laws to mitigate the adverse impact of exposure to tobacco smoke and reduce the health burden of heart diseases for their residents.

Professor Patrick Tan, Senior Vice-Dean for Research at Duke-NUS

Photo by Andres Siimon on Unsplash