Abstract
BackgroundConsistent evidence has demonstrated that smoking ban policies save lives, but impacts on health inequalities are uncertain as few studies have assessed post-ban effects by socioeconomic status (SES) and findings have been inconsistent. The aim of this study was to assess the effects of the national Irish smoking ban on ischemic heart disease (IHD), stroke, and chronic obstructive pulmonary disease (COPD) mortality by discrete and composite SES indicators to determine impacts on inequalities.MethodsCensus data were used to assign frequencies of structural and material SES indicators to 34 local authorities across Ireland with a 2000–2010 study period. Discrete indicators were jointly analysed through principal component analysis to generate a composite index, with sensitivity analyses conducted by varying the included indicators. Poisson regression with interrupted time-series analysis was conducted to examine monthly age and gender-standardised mortality rates in the Irish population, ages ≥35 years, stratified by tertiles of SES indicators. All models were adjusted for time trend, season, influenza, and smoking prevalence.ResultsPost-ban mortality reductions by structural SES indicators were concentrated in the most deprived tertile for all causes of death, while reductions by material SES indicators were more equitable across SES tertiles. The composite indices mirrored the results of the discrete indicators, demonstrating that post-ban mortality decreases were either greater or similar in the most deprived when compared to the least deprived for all causes of death.ConclusionsOverall findings indicated that the national Irish smoking ban reduced inequalities in smoking-related mortality. Due to the higher rates of smoking-related mortality in the most deprived group, even equitable reductions across SES tertiles resulted in decreases in inequalities. The choice of SES indicator was influential in the measurement of effects, underscoring that a differentiated analytical approach aided in understanding the complexities in which structural and material factors influence mortality.
Highlights
The Republic of Ireland was the first country in the world to implement a national workplace smoking ban on March 29, 2004
The Spearman correlation coefficients highlighted the complex relationships between socioeconomic status (SES) indicators (Table 2)
Foreign status as a non-Irish/non-UK national was inversely correlated with all indicators except for a weakly positive correlation with population unemployment (0.10) and a moderately positive correlation with rented/free housing tenure (0.41)
Summary
The Republic of Ireland was the first country in the world to implement a national workplace smoking ban on March 29, 2004 The implementation of this comprehensive legislation, including a ban on smoking in restaurants, pubs, and bars, resulted in large immediate decreases in mortality due to ischemic heart disease (IHD), stroke, and chronic obstructive pulmonary disease (COPD) [1]. In Ireland, manual occupation groups and unemployed groups have the greatest prevalence of active smoking in the population [8,9] These occupational groups have greater rates of mortality due to cardiovascular and respiratory diseases [10]. The aim of this study was to assess the effects of the national Irish smoking ban on ischemic heart disease (IHD), stroke, and chronic obstructive pulmonary disease (COPD) mortality by discrete and composite SES indicators to determine impacts on inequalities
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
