Smoking Ban: A Long-term Analysis of the Malta Paradox in a Population of over 400,000 Subjects

Robert Xuereb, Sandra Distefano, Caroline Magri, Neville Calleja, Victor Grech


Objectives: The introduction of laws that make indoor public areas and workplaces smoke-free has resulted in a significant
reduction in the incidence of acute coronary syndromes (ACS). Malta was the second European country to introduce the
smoking ban legislation in April 2004. The purpose of the study was to investigate the impact of the smoking ban in Malta on
ACS morbidity and mortality.
Methods: The number of ACS hospital admissions and the number of cardiovascular deaths were retrospectively analysed.
The annual data for 5 years prior to and following the introduction of the Tobacco Act were obtained according to age-groups
for both genders. Poisson regression analyses were performed to assess for decline in ACS admission and cardiovascular
Results: The ACS admission rate increased throughout the 5 years following the introduction of the smoking ban. There was
no change in mortality rate in the 5 years following the legislation, except in 2007 when a small but significant decline was
Conclusions: The Malta smoking ban did not have a significant impact on cardiovascular mortality and ACS admissions
rates, indicating the need for proper enforcement of the public smoking ban and increase in public awareness regarding the
adverse effects of smoking.
Key words: Coronary heart disease; Mortality; Prevention; Smoking.

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Copyright (c) 2015 Caroline Magri, Robert Xuereb, Sandra Distefano, Neville Calleja, Victor Grech

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