Wednesday, December 02, 2009

Heart Disease Death Rate Increased by 16% in First Year Following Indy Smoking Ban; By IOM Committee's Logic, Ban Caused Increase in Heart Attacks

Data I am reporting here today from the Marion County Health Department indicate that the heart disease death rate in Marion County increased by 16% in the first year following implementation of the Indianapolis smoking ban.

The ban, which affected all workplaces, including restaurants but excluding bars, went into effect on March 1, 2006. Had the smoking ban resulted in an immediate decline in heart attacks, as claimed by a number of anti-smoking groups and researchers and by a special Institute of Medicine committee, one would have expected the heart disease death rate in Marion County to have decreased in 2006, compared to 2005.

Data from the Marion County Health Department, however, show that the age-adjusted heart disease death rate for Marion County actually increased by 16% from 2005 to 2006, going from 171.0 to 197.6 deaths per 100,000 population.

This reversed a trend of declining heart disease death rates prior to the smoking ban. The rate had declined by 4.4% from 2002 to 2003, by 6.0% from 2003 to 2004, and by 5.8% from 2004 to 2005. Thus, the increase of 16% observed from 2005 to 2006 was a striking increase that coincided precisely with the implementation of the workplace and restaurant smoking ban.

The Indianapolis yellow pages list more than 4,000 restaurants in the city; thus, one would expect that the decline in secondhand smoke exposure was substantial. If anti-smoking groups were correct that brief exposure to secondhand smoke is triggering heart attacks in many nonsmokers, there certainly should have been a decline in heart disease death rates within one year. At very least, one would not have observed a 16% increase in heart disease deaths.

The Rest of the Story

By the logic of many anti-smoking groups and researchers, and by the logic of the Institute of Medicine committee that reviewed this issue, the Indianapolis smoking ban resulted in an immediate and dramatic 16% increase in heart disease deaths.

This increase was a striking departure from the consistent and stable trend of about a 4%-6% annual decline in heart disease deaths during the three previous years.

Now, do I believe that the smoking ban in Indianapolis actually caused the observed increase in heart disease deaths? Of course not. But my point is simply this: by the logic being used by anti-smoking groups and researchers and by the IOM committee, these data demonstrate that the smoking ban caused a dramatic and immediate increase in heart disease deaths.

You see, the anti-smoking groups can't have it both ways. They can't argue that when a smoking ban is associated with a dramatic decline in heart attacks, that decline was caused by the smoking ban, but when the ban is associated with an increase in heart attacks, that increase was not caused by the ban. The anti-smoking groups are truly in a catch-22 situation in trying to explain these data.

If anti-smoking groups try to explain away this finding by arguing that the increase heart disease deaths was due to factors other than the smoking ban, then the same explanation could be used to argue that the observed decreases in heart attacks in other cities were due to factors other than the smoking ban.

If anti-smoking groups defend the methodology and conclusions of previous studies, then they are forced to acknowledge that these data refute the conclusions of those studies. You can't just cherry-pick the findings you like and ignore those that don't support your hypothesis. Of course, that's exactly what the IOM committee did in reaching its conclusion.

This story demonstrates why one cannot properly study this issue by analyzing data from a single community. One needs to systematically look at a large sample of communities with and without smoking bans, especially in areas with a large population. So far, the only study which has employed such a methodology has found no effect of smoking bans on heart attacks.

Once again, I challenge those anti-smoking groups which have publicized data from other smoking ban/heart attack studies to publicize these data. Will anti-smoking groups only share with the public the findings which are favorable to them and their pre-determined conclusions? Or will they share relevant data which refute those conclusions as well? Are they interested in the truth, or are they just interested in data which supports their a priori position?

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