Variation in hospital admission for AMI unlikely to be attributable to smoking legislation.

Fransesco Barone-Adesi and colleagues present an interesting analysis of hospital admissions forMI around the introductionof Italy’s national smoking ban. They claim to have observed an 11% reduction in admissions aged ,60, almost entirely attributable to removal of exposure to ‘side smoke’, by comparing 5 months admissions after introduction of the ban, with a comparable period in the previous year. Such a marked and early effect would be of considerable public health and political interest. However, it should be noted that they report no reduction overall (RR 1⁄4 1.01, 0.97–1.06), and it was only by dividing admissions into four groups, men and women and young (,60) and not so young, that a significant reduction (RR 1⁄4 0.75, 0.58–0.96) could be observed in the smallest group, young women, 3% of all. They also provide comparable data for three more pre-ban years, and inspection of the full 5-year data demonstrates considerable variation. All 20 observations (5 years and four age–sex groups) fall well within 95% confidence limits of respective mean values; there is no significant reduction of admissions in the single post-ban period. It is perhaps premature to report an agespecific effect of anti-smoking legislation on incidence of MI.