The smoke-free legislation in Hong Kong: its impact on mortality

ObjectivesTo examine trends in deaths for conditions associated with secondhand smoke exposure over the years prior to and following the implementation of a smoke-free policy in Hong Kong.DesignTime-series study.SettingDeath registration data from Hong Kong Special Administrative Region (SAR) Government Census and Statistics Department.ParticipantsAll deaths registered from 1 January 2001 to 31 December 2011.Main outcome measuresDeaths for conditions associated with passive smoking include cardiovascular disease (CVD), respiratory disease and other causes.ResultsThere was a decline in the annual proportional change for ischaemic heart disease (IHD), acute myocardial infarction (AMI) and CVD mortality in the year after the intervention for all ages and those aged 65 years or older. There were also clear declines in the cool season peaks for these three conditions in the first postintervention year. There was a further drop in the cool season peak for AMI among all ages in the year after the exemptions ceased. No declines in annual proportional change or changes in seasonal peaks of mortality were found for any of the control conditions.ConclusionsThe findings in this study add to the evidence base, as summarised in the Surgeon General's report, extending the impact of effective smoke-free legislation to those aged 65 years or older and to cerebrovascular events in younger age groups. They also reinforced the need for comprehensive, enforced and effective smoke-free laws if the full extent of the health gains are to be achieved.