gms | German Medical Science

GMDS 2015: 60. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V. (GMDS)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie

06.09. - 09.09.2015, Krefeld

Impact of Second-Hand Smoke on Population Health – Meta-Analysis and Health Impact Assessment

Meeting Abstract

Suche in Medline nach

  • Florian Fischer - Universität Bielefeld, Fakultät für Gesundheitswissenschaften, Bielefeld, Deutschland
  • Alexander Krämer - Universität Bielefeld, Fakultät für Gesundheitswissenschaften, Bielefeld, Deutschland

GMDS 2015. 60. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e.V. (GMDS). Krefeld, 06.-09.09.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocAbstr. 007

doi: 10.3205/15gmds152, urn:nbn:de:0183-15gmds1525

Veröffentlicht: 27. August 2015

© 2015 Fischer et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Introduction: Second-hand smoke (SHS) is the most important contaminant of indoor air. Evidence of the adverse health effects attributable to second-hand smoke (SHS) exposure is available [1]. Concern about these effects has contributed to the declining social acceptance of smoking, which resulted in legislation bringing in smoking bans and action to reduce SHS exposure [2]. The risks associated with SHS exposure are highly relevant, because the majority of people are regularly, and usually involuntarily, exposed to SHS. This study aims to quantify the effects of SHS exposure. Effect sizes for the association between SHS exposure and ischaemic heart diseases (IHD), chronic obstructive pulmonary diseases (COPD), and stroke will be calculated. In a Health Impact Assessment (HIA) the morbidity for the three outcomes in the German population will be estimated and forecasted. Furthermore, this study will predict the effects of policies designed to reduce SHS exposure.

Methods: The study design consists of three steps. Firstly, a systematic literature review was conducted in PubMed to identify articles dealing with the association between SHS and the three outcomes IHD, COPD, and stroke. Cohort and case-control studies were included in the review. After excluding articles following a screening of titles/abstracts and full texts, an additional manual search in the reference lists of all full-texts and a quality assessment, 24 articles were included in the meta-analysis. The meta-analysis using a random effects model was conducted in MIX 2.0 Pro, which is a statistical add-in to perform meta-analysis with Microsoft Excel [3]. Effect sizes stratified for sex and for both sexes combined were calculated. As a third step, a health impact assessment was performed using DYNAMO-HIA, which is a generic software tool applying a Markov model [4]. Input parameters were data on the German population and disease prevalences already available in DYNAMO-HIA. Information on SHS exposure in Germany taken from survey data from the Robert Koch Institute [5] and the calculated effect sizes were used in the modeling approach to calculate the impact of SHS exposure in the German population.

Results: The synthesis of primary studies revealed significant effect sizes for the association between SHS exposure and all three outcomes. The highest RR for both sexes combined was found for COPD (RR = 1.66, 95% CI: 1.38 – 2.00). The RR for both sexes combined was 1.35 (95% CI: 1.22 – 1.50) for stroke and 1.27 (95% CI: 1.10 – 1.48) for IHD. The risks were higher in women than in men for all three outcomes. Low heterogeneity was observed among the primary studies for all three outcomes.

According to the health impact assessment, overall 687,254 IHD cases, 231,973 COPD cases and 288,015 stroke cases attributable to SHS exposure were estimated in Germany for 2014. Under the assumption that the population prevalence of these diseases and the prevalence of SHS exposure remain constant, the total number of cases will increase due to demographic ageing. According to the estimations, 795,709 IHD cases (+15.8%), 270,388 COPD cases (+16.6%) and 361,230 stroke cases (+25.4%) are expected for 2040. Although the effect sizes for the associations between SHS exposure and adverse health effects applied in this HIA were higher in women than in men for all three outcomes, the absolute number of cases attributable to SHS is lower in women than in men. This is due to the higher population prevalence rates of the three diseases in men compared to women.

The scenario of a total eradication of SHS exposure leads to a reduction of 50% in cases compared to the reference scenario in 2040 for all three disease entities. The scenario with a 20% success rate reduces the prevalence rates for the three diseases in 2040 to a level which is comparable to the situation in 2014.

Discussion: Up to now, the effects of SHS exposure on population health are still controversial. This is the first study to calculate effect sizes for the association between SHS exposure and the disease outcomes IHD, COPD, and stroke. It allows a comparison of the effects for the selected outcomes, because the same methodology was used for the systematic literature review and meta-analysis. Overall, the effect sizes are comparable with previous findings in meta-analyses and therefore assumed to be reliable.

The stratification for sex performed in this study is highly relevant, because the effect sizes as well as the prevalence of diseases and the prevalence of SHS exposure differ between the sexes. The results highlight the relevance of SHS exposure, because it affects several chronic disease conditions and has a major impact on the population’s health. Therefore, public health campaigns to protect non-smokers are urgently needed. Additionally, further research on SHS exposure and its effects is needed.


References

1.
U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. 2006.
2.
Callinan JE, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews. 2010;4:Cd005992.
3.
MIX Pro [Internet]. Meta-analysis with MIX 2.0. 2013 [cited 2014 May 5]. Available from: http://www.meta-analysis-made-easy.com/index.html Externer Link
4.
Lhachimi SK, Nusselder WJ, Smit HA, van Baal P, Baili P, Bennett K, et al. DYNAMO-HIA – a Dynamic Modeling tool for generic Health Impact Assessments. PLoS One. 2012;7(5):e33317.
5.
Lampert T, List SM. Gesundheitsrisiko Passivrauchen. Berlin: Robert Koch-Institut; 2010.