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Original article

Vol. 146 No. 5152 (2016)

Cardiorespiratory hospitalisation and mortality reductions after smoking bans in Switzerland

  • Ana M Vicedo-Cabrera
  • Martin Röösli
  • Dragana Radovanovic
  • Leticia Grize
  • Fabienne Witassek
  • Christian Schindler
  • Laura Perez
Cite this as:
Swiss Med Wkly. 2016;146:w14381


INTRODUCTION: Smoking bans are considered one of the most effective policies to reduce population exposure to tobacco smoke and prevent adverse health outcomes. However, evidence on the effect of contextual variables on the effectiveness of smoking bans is still lacking.

AIMS: The patchwork of cantonal smoke-free laws in Switzerland was used as a quasi-experimental setting to assess changes after their introduction in: hospitalisations and mortality due to cardiorespiratory diseases in adults; total hospitalisations and hospitalisations due to respiratory disorders in children; and the modifying effects of contextual factors and the effectiveness of the laws.

METHODS: Using hospital and mortality registry data for residents in Switzerland (2005–2012), we conducted canton-specific interrupted time-series analyses followed by random effects meta-analyses to obtain nationwide smoking ban estimates by subgroups of age, sex and causes of hospitalisation or death. Heterogeneity of the impact caused by strictness of the ban and other smoking-related characteristics of the cantons was explored through meta-regression.

RESULTS: Total hospitalisation rates due to cardiovascular and respiratory diseases did not significantly change after the introduction of the ban. Post-ban changes were detected in ischaemic heart disease hospitalisations, with a 2.5% reduction (95% confidence interval [CI)] −6.2 to 1.3%) for all ages and 5.5% (95% CI −10.8 to −0.2%) in adults 35–64 years old. Total mortality due to respiratory diseases decreased by 8.2% (95% CI −15.2 to −0.6%) over all ages, and chronic obstructive pulmonary disease mortality decreased by 14.0% (95% CI −22.3 to −4.5%) in adults ≥65 years old. Cardiovascular mortality did not change after the introduction of the ban, but there was an indication of post-ban reductions in mortality due to hypertensive disorders (−5.4%, 95% CI −12.6 to 2.3%), and congestive heart failure (−6.0%, 95% CI −14.5 to 3.4%). No benefits were observed for hospitalisations due to respiratory diseases in children or for infant mortality. The type of smoking ban implemented explained the heterogeneity of benefits across cantons for some outcomes.

CONCLUSION: Smoking bans in Switzerland were associated with overall reductions in cardiovascular and respiratory hospitalisation and mortality in adults.


  1. Hoffman SJ, Tan C. Overview of systematic reviews on the health-related effects of government tobacco control policies. BMC Public Health. 2015;15(1):744. doi:
  2. Jones MR, Barnoya J, Stranges S, Losonczy L, Navas-Acien A. Cardiovascular Events Following Smoke-Free Legislations: An Updated Systematic Review and Meta-Analysis. Curr Environ Health Rep. 2014;1(3):239–49. doi:
  3. Lee PN, Fry JS, Forey BA. A review of the evidence on smoking bans and incidence of heart disease. Regul Toxicol Pharmacol. 2014;70(1):7–23. doi:
  4. Mackay DF, Irfan MO, Haw S, Pell JP. Meta-analysis of the effect of comprehensive smoke-free legislation on acute coronary events. Heart. 2010;96(19):1525–30. doi:
  5. Tan CE, Glantz SA. Association between smoke-free legislation and hospitalizations for cardiac, cerebrovascular, and respiratory diseases: a meta-analysis. Circulation. 2012;126(18):2177–83. doi:
  6. Been JV, Nurmatov UB, Cox B, Nawrot TS, van Schayck CP, Sheikh A. Effect of smoke-free legislation on perinatal and child health: a systematic review and meta-analysis. Lancet. 2014;383(9928):1549–60. doi:
  7. Cox B, Vangronsveld J, Nawrot TS. Impact of stepwise introduction of smoke-free legislation on population rates of acute myocardial infarction deaths in Flanders, Belgium. Heart. 2014;100(18):1430–5. doi:
  8. Mackay D, Haw S, Ayres JG, Fischbacher C, Pell JP. Smoke-free legislation and hospitalizations for childhood asthma. N Engl J Med. 2010;363(12):1139–45. doi:
  9. Stallings-Smith S, Zeka A, Goodman P, Kabir Z, Clancy L. Reductions in cardiovascular, cerebrovascular, and respiratory mortality following the national irish smoking ban: interrupted time-series analysis. PLoS One. 2013;8(4):e62063. doi:
  10. Ye X, Yao Z, Gao Y, Xu Y, Xu Y, Zhu Z, et al. Second-hand smoke exposure in different types of venues: before and after the implementation of smoke-free legislation in Guangzhou, China. BMJ Open. 2014;4(2):e004273. doi:
  11. Tabuchi T, Hoshino T, Nakayama T. Are Partial Workplace Smoking Bans as Effective as Complete Smoking Bans? A National Population-Based Study of Smoke-Free Policy Among Japanese Employees. Nicotine Tob Res. 2016;18(5):1265–73. doi:
  12. Zablocki RW, Edland SD, Myers MG, Strong DR, Hofstetter CR, Al-Delaimy WK. Smoking ban policies and their influence on smoking behaviors among current California smokers: a population-based study. Prev Med. 2014;59:73–8. doi:
  13. Troelstra SA, Bosdriesz JR, de Boer MR, Kunst AE. Effect of Tobacco Control Policies on Information Seeking for Smoking Cessation in the Netherlands: A Google Trends Study. PLoS One. 2016;11(2):e0148489. doi:
  14. WHO report on the global tobacco epidemic, 2015: raising taxes on tobacco. Geneva; World Health Organization: 2015.
  15. Vicedo-Cabrera AM, Schindler C, Radovanovic D, Grize L, Witassek F, Dratva J, et al. Benefits of smoking bans on preterm and early-term births: a natural experimental design in Switzerland. Tob Control. 2016 Apr 26;pii:tobaccocontrol-2015-052739. doi: 10.1136/tobaccocontrol-2015-052739.
  16. Dusemund F, Baty F, Brutsche MH. Significant reduction of AECOPD hospitalisations after implementation of a public smoking ban in Graubünden, Switzerland. Tob Control. 2015;24(4):404–7. doi:
  17. Bonetti PO, Trachsel LD, Kuhn MU, Schulzki T, Erne P, Radovanovic D, et al. Incidence of acute myocardial infarction after implementation of a public smoking ban in Graubünden, Switzerland: two year follow-up. Swiss Med Wkly. 2011;141:w13206.
  18. Trachsel LD, Kuhn MU, Reinhart WH, Schulzki T, Bonetti PO. Reduced incidence of acute myocardial infarction in the first year after implementation of a public smoking ban in Graubuenden, Switzerland. Swiss Med Wkly. 2010;140(9-10):133–8.
  19. Di Valentino M, Muzzarelli S, Limoni C, Porretta AP, Rigoli A, Barazzoni F, et al. Reduction of ST-elevation myocardial infarction in Canton Ticino (Switzerland) after smoking bans in enclosed public places – No Smoke Pub Study. Eur J Public Health. 2015;25(2):195–9. doi:
  20. Huang J, King BA, Babb SD, Xu X, Hallett C, Hopkins M. Sociodemographic Disparities in Local Smoke-Free Law Coverage in 10 States. Am J Public Health. 2015;105(9):1806–13. doi:
  21. Stallings-Smith S, Goodman P, Kabir Z, Clancy L, Zeka A. Socioeconomic differentials in the immediate mortality effects of the national Irish smoking ban. PLoS One. 2014;9(6):e98617. doi:
  22. Khuder SA, Milz S, Jordan T, Price J, Silvestri K, Butler P. The impact of a smoking ban on hospital admissions for coronary heart disease. Prev Med. 2007;45(1):3–8. doi:
  23. Eisner MD, Iribarren C, Yelin EH, Sidney S, Katz PP, Sanchez G, et al. The impact of SHS exposure on health status and exacerbations among patients with COPD. Int J Chron Obstruct Pulmon Dis. 2009;4:169–76. doi:
  24. Cesaroni G, Forastiere F, Agabiti N, Valente P, Zuccaro P, Perucci CA. Effect of the Italian smoking ban on population rates of acute coronary events. Circulation. 2008;117(9):1183–8. doi:
  25. Humair J-P, Garin N, Gerstel E, Carballo S, Carballo D, Keller P-F, et al. Acute respiratory and cardiovascular admissions after a public smoking ban in Geneva, Switzerland. PLoS One. 2014;9(3):e90417. doi:
  26. Agüero F, Dégano IR, Subirana I, Grau M, Zamora A, Sala J, et al. Impact of a partial smoke-free legislation on myocardial infarction incidence, mortality and case-fatality in a population-based registry: the REGICOR Study. PLoS One. 2013;8(1):e53722. doi:
  27. Christensen TM, Møller L, Jørgensen T, Pisinger C. The impact of the Danish smoking ban on hospital admissions for acute myocardial infarction. Eur J Prev Cardiol. 2014;21(1):65–73. doi:
  28. Rajkumar S, Stolz D, Hammer J, Moeller A, Bauer GF, Huynh CK, et al. Effect of a smoking ban on respiratory health in nonsmoking hospitality workers: a prospective cohort study. J Occup Environ Med. 2014;56(10):e86–91. doi:
  29. Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K, et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. In: Cochrane Database of Systematic Reviews [Internet]. John Wiley & Sons, Ltd; 2016 [cited 2016 Mar 14]. Available from:
  30. Stallings-Smith S, Zeka A, Goodman P, Kabir Z, Clancy L. Reductions in cardiovascular, cerebrovascular, and respiratory mortality following the national irish smoking ban: interrupted time-series analysis. PLoS One. 2013;8(4):e62063. doi:
  31. Hansell AL, Walk JA, Soriano JB. What do chronic obstructive pulmonary disease patients die from? A multiple cause coding analysis. Eur Respir J. 2003;22(5):809–14. doi:
  32. Been JV, Millett C, Lee JT, van Schayck CP, Sheikh A. Smoke-free legislation and childhood hospitalisations for respiratory tract infections. Eur Respir J. 2015;46(3):697–706. doi:
  33. Fernández MF, Artacho-Cordón F, Freire C, Pérez-Lobato R, Calvente I, Ramos R, et al. Trends in children’s exposure to second-hand smoke in the INMA-Granada cohort: an evaluation of the Spanish anti-smoking law. Environ Res. 2015;138:461–8. doi:
  34. Kairouz S, Lasnier B, Mihaylova T, Montreuil A, Cohen JE. Smoking restrictions in homes after implementation of a smoking ban in public places. Nicotine Tob Res. 2015;17(1):41–7. doi:
  35. Mons U, Nagelhout GE, Allwright S, Guignard R, van den Putte B, Willemsen MC, et al. Impact of national smoke-free legislation on home smoking bans: findings from the International Tobacco Control Policy Evaluation Project Europe Surveys. Tob Control. 2013;22(e1):e2–9. doi:
  36. Barr CD, Diez DM, Wang Y, Dominici F, Samet JM. Comprehensive smoking bans and acute myocardial infarction among Medicare enrollees in 387 US counties: 1999-2008. Am J Epidemiol. 2012;176(7):642–8. doi:

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