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2017 ; 2
(6
): 627-634
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Hospital Admissions for Myocardial Infarction and Stroke Before and After the
Trans-Fatty Acid Restrictions in New York
#MMPMID28403435
Brandt EJ
; Myerson R
; Perraillon MC
; Polonsky TS
JAMA Cardiol
2017[Jun]; 2
(6
): 627-634
PMID28403435
show ga
IMPORTANCE: Trans-fatty acids (TFAs) have deleterious cardiovascular effects.
Restrictions on their use were initiated in 11 New York State (NYS) counties
between 2007 and 2011. The US Food and Drug Administration plans a nationwide
restriction in 2018. Public health implications of TFA restrictions are not well
understood. OBJECTIVE: To determine whether TFA restrictions in NYS counties were
associated with fewer hospital admissions for myocardial infarction (MI) and
stroke compared with NYS counties without restrictions. DESIGN, SETTING, AND
PARTICIPANTS: We conducted a retrospective observational pre-post study of
residents in counties with TFA restrictions vs counties without restrictions from
2002 to 2013 using NYS Department of Health's Statewide Planning and Research
Cooperative System and census population estimates. In this natural experiment,
we included those residents who were hospitalized for MI or stroke. The data
analysis was conducted from December 2014 through July 2016. EXPOSURE: Residing
in a county where TFAs were restricted. MAIN OUTCOMES AND MEASURES: The primary
outcome was a composite of MI and stroke events based on primary discharge
diagnostic codes from hospital admissions in NYS. Admission rates were calculated
by year, age, sex, and county of residence. A difference-in-differences
regression design was used to compare admission rates in populations with and
without TFA restrictions. Restrictions were only implemented in highly urban
counties, based on US Department of Agriculture Economic Research Service Urban
Influence Codes. Nonrestriction counties of similar urbanicity were chosen to
make a comparison population. Temporal trends and county characteristics were
accounted for using fixed effects by county and year, as well as linear time
trends by county. We adjusted for age, sex, and commuting between restriction and
nonrestriction counties. RESULTS: In 2006, the year before the first restrictions
were implemented, there were 8.4 million adults (53.6% female) in highly urban
counties with TFA restrictions and 3.3 million adults (52.3% female) in highly
urban counties without restrictions. Twenty-five counties were included in the
nonrestriction population and 11 in the restriction population. Three or more
years after restriction implementation, the population with TFA restrictions
experienced significant additional decline beyond temporal trends in MI and
stroke events combined (-6.2%; 95% CI, -9.2% to -3.2%; P?.001) and MI (-7.8%;
95% CI, -12.7% to -2.8%; P?=?.002) and a nonsignificant decline in stroke (-3.6%;
95% CI, -7.6% to 0.4%; P?=?.08) compared with the nonrestriction populations.
CONCLUSIONS AND RELEVANCE: The NYS populations with TFA restrictions experienced
fewer cardiovascular events, beyond temporal trends, compared with those without
restrictions.
|*Legislation, Food
[MESH]
|*Trans Fatty Acids
[MESH]
|Aged
[MESH]
|Case-Control Studies
[MESH]
|Databases, Factual
[MESH]
|Female
[MESH]
|Hospitalization/*statistics & numerical data
[MESH]