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Original Investigation
April 12, 2017

Hospital Admissions for Myocardial Infarction and Stroke Before and After the Trans-Fatty Acid Restrictions in New York

Author Affiliations
  • 1Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
  • 2School of Pharmacy and Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
  • 3University of Colorado Anschutz Medical Campus, Aurora
  • 4Department of Medicine, University of Chicago, Chicago, Illinois
JAMA Cardiol. Published online April 12, 2017. doi:10.1001/jamacardio.2017.0491
Key Points

Question  What is the association between the trans-fatty acid restrictions in New York State and hospital admissions for myocardial infarction and stroke?

Findings  In this study using data from the New York State Department of Public Health (2002-2013), there was an additional 6.2% decline in hospital admissions for myocardial infarction and stroke among populations living in counties with vs without trans-fatty acid restrictions. The decline in events reached statistical significance 3 or more years after restrictions were implemented.

Meaning  Restrictions on trans-fatty acid consumption are associated with a decrease in hospitalization for cardiovascular events.

Abstract

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.

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