Singapore's Anti-Smoking Law Reduced Heart Attack-Related Death Rates, Especially Among Elderly: Study

The worldwide movement to curb cigarette use in public spaces reached a significant milestone when cigarette sales were banned in several countries. Bhutan became a catalyst for many nations after it banned cigarette sales in 2010. Singapore also stands out, as it has implemented a stringent no-smoking policy in public spaces between 2013 and 2017.

Anti-Smoking Law Reduces Heart Attack Rates in Singapore

A group of scientists has evaluated the impact of Singapore's legislation on heart attack rates. To conduct this assessment, Interesting Engineering reported that the researchers meticulously examined monthly data gathered from the Singapore Myocardial Infarction Registry between January 2010 and December 2019.

The research findings shed light on the impact of Singapore's smoking restrictions, particularly after their expansion in 2013 to encompass more public spaces.

Before this extension, the rate of heart attacks surged at a monthly rate of 0.9 per million individuals. However, following the 2013 expansion, this rate dwindled to 0.6 per million.

The study conducted a meticulous analysis, revealing that without implementing these legislative measures, an additional 19,591 heart attacks may have occurred in individuals aged 65 and above.

The number was notably lower at 1,325 for those under 65. Moreover, it was observed that the elderly demographic and male individuals reaped the greatest benefits from the broader smoke-free legislation.

These findings find support in a comprehensive meta-analysis that included 18 prior studies conducted across Europe, North America, and New Zealand.

This broader analysis showed an overall 13% reduction in the risk of heart attacks following the implementation of smoke-free legislation. However, the research also brings attention to a subsequent development.

Findings of the Study

While the study acknowledged that there wasn't a substantial decline in heart attack cases after the 2017 legislation, it emphasized that an average reduction in rates was witnessed across all age groups and in both genders.

The researchers accessed monthly reports of Acute Myocardial Infarction (AMI) cases from the Singapore Myocardial Infarction Registry from January 2010 to December 2019.

The National Registry of Diseases Office (NRDO) diligently maintains this invaluable database and is responsible for tracking specific diseases in Singapore. Notably, AMI notifications to the NRDO are legally mandated under the National Registry of Diseases Act.

For the analysis, the researchers employed the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 410 to identify AMI cases diagnosed between 2010 and 2011.

Subsequently, for cases diagnosed from 2012 onwards, they relied on the ICD-10 (Australian Modification) codes I21 and I22. The research methodology aligns with the World Health Organization's (WHO) framework for Monitoring Trends and Determinants in Cardiovascular Disease.

Within this approach, an AMI is considered a distinct case if it occurs 28 days or more after a previous AMI. Additionally, the research team subjected their diagnoses to rigorous central adjudication by physicians.

To ensure accuracy, these physicians based their assessments on medical records, clinical presentations, and laboratory test results. Annual audits were conducted with a minimum compliance threshold of 95% to maintain data precision and inter-rater reliability.

To calculate the monthly incidence of AMIs per 1,000,000 population, the researchers divided the total number of AMI reports each month by the monthly population estimates.