Association between partial smoking ban legislation and acute coronary syndrome: A nationwide analysis

Tobacco smoking is a major risk factor for acute coronary syndrome (ACS) and acute myocardial infarction (AMI). While comprehensive smoking bans reduce cardiovascular events, the effectiveness of partial smoking ban legislation (pSBL) remains uncertain. In April 2020, Japan implemented a pSBL targeting certain public facilities. This study aimed to evaluate the impact of this nationwide pSBL on ACS and AMI hospitalizations.

We conducted an interrupted time series analysis using data from the JROAD-DPC database, covering hospitalizations for ACS and AMI across Japan and the Tokyo area from April 2018 to March 2022. Ordinary least-squares regression was used to assess hospitalization trends before and after pSBL implementation. Seasonal adjustments were applied.

No significant changes were observed in ACS hospitalizations nationwide [slope difference (95 % CI): 19.97 (-16.54, 86.48)] or in the Tokyo area [2.43 (-5.10, 9.97)]. Similar findings were noted for AMI nationwide [9.18 (-38.95, 57.31)] and in Tokyo [1.48 (-3.60, 6.55)].

The nationwide pSBL in Japan did not significantly reduce ACS or AMI hospitalizations. These findings highlight the limited effectiveness of partial smoking bans and underscore the need for more comprehensive tobacco control policies to achieve meaningful reductions in cardiovascular events.