Rauchverbote in öffentlichen Räumen: Aktuelle epidemiologische Evidenz für kardiovaskuläre Gesundheitseffekte auf Bevölkerungsebene

Zusammenfassung

In den letzten Jahren traten in mehreren Staaten Rauchverbote in öffentlichen Räumen einschließlich der Gastronomie in Kraft. Bisher wurden acht ökologische Studien aus den USA, Kanada und Italien publiziert, die Raten der Krankenhauseinweisungen für Herzinfarkt bzw. koronare Herzkrankheit nach Einführung eines Rauchverbots untersuchten. Der vorliegende Beitrag gibt einen Überblick über diese Studien und diskutiert aus epidemiologischer Sicht deren Aussagekraft und mögliche Fehlerquellen. Der zeitliche Zusammenhang des Rückgangs der Herzinfarktraten mit der Rauchverbotseinführung, die Konsistenz dieser Assoziation in mehreren Staaten sowie die biologische Plausibilität aufgrund der bekannten akuten kardiovaskulären Effekte des Passivrauchens sprechen für eine kausale Assoziation. Sollte sich dies bestätigen, wären Rauchverbote in öffentlichen Räumen eine sehr effektive Maßnahme zum Schutz der Gesundheit der Bevölkerung.

Abstract

During the past years smoking bans in public places including hospitality venues have been introduced in several countries. Up to now, eight ecological studies on hospital admission rates due to acute myocardial infarction or coronary events after introduction of a smoking ban in the United States, Canada, and Italy have been published. This article reviews these studies and discusses their significance and potential sources of error from an epidemiological point of view. The chronological order of reduction in acute myocardial infarction rates following the smoking ban, the consistency of this association in several countries, and the biological plausibility because of the known acute cardiovascular effects of secondhand smoke suggest a causal association. Thus, if this turns out to be true public smoking bans will be a very effective public health measure.

Schlüsselwörter

Passivrauchen - Nichtraucherschutz - Rauchverbot - Herzinfarkt - Prävention

Key words

environmental tobacco smoke - non-smoker protection - smoking ban - myocardial infarction - prevention

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