Singapore: Six years before researchers warned that Asian countries are at tobacco smoking epidemic risk, Singapore has passed a legislation extending to ban smoking in communal areas of residential blocks and other outdoor spaces.
A study published in the open access journal BMJ Global Health now revealed that the legislation banning smoking in residential areas saved more than 20,000 people above the age of 65 from heart attacks.
As many as 67 countries in the world have imposed ban on smoking. These bans however largely confined to indoor smoking bans rather than those for housing estates and outdoor spaces.
However, health experts noticed dramatic change when Singapore extended the ban in residential blocks where 80% of the population lives, as well as outdoor spaces, including covered link-ways, overhead bridges, and within 5 meters of bus stops.
The restrictions were further extended to all parks in 2016, and to all educational institutions and all buses and taxis in 2017.
To assess the impact of the various pieces of legislation on heart attack rates, the researchers analyzed monthly data provided by the Singapore Myocardial Infarction Registry from January 2010 through to December 2019.
During this period, a total of 133,868 heart attacks were reported. Of this total, 87,763 (about 66%) occurred in men and 80,597 (about 60%) of the heart attacks were reported in people aged 65+.
Before the 2013 extension, the occurrences of heart attacks among those aged 65+ was around 10 times that of those under 65. And the rate of cases among men was nearly double that of women.
The overall numbers of heart attacks went up by a rate of 0.9 per million people every month before the 2013 extension. But after the ban, this rate fell to 0.6/million, indicating that 2,097 additional heart attacks, overall, might have occurred without it, estimate the researchers.
The study also found that older people and men were the primary beneficiaries of the extended ban. The monthly fall in heart attack rate among those aged 65+ was almost 15 times that of younger people: 5.9/million vs. 0.4/million.
The findings show that 19,591 additional heart attacks might have occurred in those aged 65+ compared with 1,325 in those under 65 had the legislation not been enacted, with potentially 4,748 cases averted in men, estimate the researchers.
This was "an unexpected study finding given that public smoke-free laws should reduce environmental smoke exposure in public places, and this should theoretically reduce the risk of smoke-induced [heart attack] cases," the researchers highlighted.
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