Smoking related discharges, bed days
and costs in the acute hospital sector
Dr Fenton Howell
HSE Tobacco Control Framework
Implementation Group
Key findings
• In 2008 there were 974,054 discharges (35+), using 3.5
million bed days, costing €2.97 billion.
• Smoking attributable diseases accounted for
– 36,255 (3.7%) discharges
– 300,756 (8.7%) bed days
– € 280 (9.4%) million
• 95% of the smoking attributable diseases were
accounted for by: Cardiovascular and Respiratory
Diseases and Cancers.
Introduction
• Illness and disease associated with smoking give
rise to costs for the individual, for society and for
the health service.
• Health service related costs include smoking
cessation services, primary care and acute care
costs.
• It is estimated that health care costs related to
smoking can involve between 5% and 15% of
health care budgets in developed countries
• Little is known about the true costs to the health
sector in Ireland of smoking.
Aims
• The aim of this study was to quantify the
impact of smoking on the acute sector.
– Number of discharges
– Bed days used
– Costs
Methods
• Age/gender specific smoking rates for current and
ex-smokers: SLAN 07.
• International relative risks for 40+ smoking
related diseases.
• Appropriateness formula calculated.
• Apply appropriateness proportions to HIPE data.
• HIPE data 2008: discharges, bed days and costs for
those age 35+.
• HIPE data from Health Research & Information
Division, ESRI.
• Abstracted using Health Atlas Ireland.
Smoking rates SLAN 2007
Percentage Male
Percentage Female
35+ yrs
45+ yrs
Current
25.8
20.8
Ex-smoker
29.9
34.8
Current
23.6
21.6
Ex-smoker
18.9
19.6
35-54 yrs
55-64 yrs
65-74 yrs
75+ yrs
31.2
20.2
18.0
14.1
24.7
32.6
39.9
43.5
29.4
21.7
11.8
14.1
18.0
18.6
21.4
20.5
35-64 yrs
65+ yrs
28.2
16.5
26.8
41.2
27.3
12.8
18.2
21.0
Cancers caused by smoking.
Internationally used relative risks
Males
Cancers caused by
smoking
Females
Current RR
Ex RR
Current
RR
Lip, oral cavity, pharynx
10.89
3.4
5.08
2.29
Oesophagus
6.76
4.46
7.75
2.79
Stomach
1.96
1.47
1.36
1.32
Pancreas
2.31
1.15
2.25
1.55
Larynx
14.6
6.34
13.02
5.16
Trachea, Bronchus, Lung
23.26
8.7
12.69
4.53
Cervix Uteri
n/a
n/a
1.59
1.14
Kidney and Renal Pelvis
2.5
1.7
1.40
1.10
Urinary bladder
3.27
2.09
2.22
1.89
Mal Neoplasm, unspec
site
4.4
2.5
2.20
1.30
Myeloid Leukaemia
1.8
1.4
1.20
1.30
Ex RR
Attributable percentages calculated
a = [pcur(rcur-1) + pex(rex-1)]*100 /
[1+pcur(rcur-1) + pex(rex-1)]
• a = attributable percentage for each disease,
• pcur = proportion of current smokers,
• pex = proportion of ex smokers,
• rcur = relative risk of current smokers
• rex = relative risk of ex smokers
• Analysed using Excel
Cancers caused by smoking: attributable %
Lip, oral cavity, pharynx
Oesophagus
Stomach
Males
76.6%
71.6%
28.0%
Females
54.7%
65.9%
12.7%
Pancreas
Larynx
Trachea, Bronchus, Lung
27.7%
83.6%
88.9%
28.5%
78.4%
77.4%
Cervix Uteri
Kidney and Renal Pelvis
Urinary bladder
0.0%
37.4%
47.7%
14.2%
10.2%
31.3%
Mal Neoplasm, unspec site
Myeloid Leukaemia
57.0%
24.6%
25.4%
9.4%
CVD caused by smoking: attributable %
Age
Males
Females
Ischaemic Heart Dis
35-54
55.5%
60.8%
Ischaemic Heart Dis
55-64
33.3%
29.0%
Ischaemic Heart Dis
65-74
21.1%
14.7%
Ischaemic Heart Dis
75+
9.1%
8.9%
Other Heart disease
35+
21.1%
12.4%
Cerebrovascular Dis
35-54
52.0%
57.4%
Cerebrovascular Dis
55-64
31.4%
39.1%
Cerebrovascular Dis
65-74
20.7%
20.2%
Cerebrovascular Dis
75+
11.4%
4.1%
Atherosclerosis
35+
32.0%
16.4%
Aortic Aneurysm
35+
66.3%
62.0%
Other Arterial Disease
35+
21.8%
23.0%
Respiratory and other diseases caused by
smoking: attributable %
Age
Male
Female
Pneumonia, Influenza
35-64
34.6%
47.9%
Pneumonia, Influenza
65+
24.8%
14.9%
Bronchitis, Emphysema
35+
89.5%
82.3%
Chronic Airway Obstruction
35+
80.8%
79.8%
Stomach Ulcer, Duodenal Ulcer
35+
57.9%
53.2%
Crohn's disease
35+
22.1%
20.6%
Peridonitis
35+
49.2%
45.3%
Cataract
45+
13.1%
12.1%
Hip #
55-64
3.9%
3.9%
Hip #
65-74
9.7%
6.1%
Hip #
75+
14.4%
14.2%
Spon Abortion
All
0.0%
6.2%
Methods
• Age/gender specific smoking rates for current and
ex-smokers: SLAN 07.
• International relative risks for 40+ smoking related
diseases.
• Appropriateness formula calculated.
• Apply appropriateness proportions to HIPE data.
• HIPE data 2008: discharges, bed days and costs for
those age 35+.
• HIPE data from Health Research & Information
Division, ESRI.
• Abstracted using Health Atlas Ireland.
Cardiovascular Disease
Discharges
Bed days
Costs
All Cardiovascular Disease (CVD)
39,349
286,442
€ 308 million
CVD caused by smoking
32,381
264,228
€ 287 million
CVD attributable to smoking
8,527
21.7%
65,888
€ 79 million
23.0%
25.7%
All Cardiovascular Disease (CVD)
27,663
223,184
€ 186 million
CVD caused by smoking
19,988
199,087
€ 164 million
CVD attributable to smoking
3,570
12.9%
31,608
€ 30 million
14.2%
16.3%
Male
Attributable percentage
Female
Attributable percentage
Cancers
Discharges
Bed days
Costs
46,123
11,877
237,080
88,047
€ 254 million
€ 94 million
6,948
55,805
€ 55 million
Attributable percentage
15.1%
23.5%
21.9%
Female
All Cancers
49,398
224,113
€248 million
Cancers caused by smoking
8,305
60,196
€ 62 million
3,452
26,892
€ 26 million
7.0%
12.0%
10.4%
Male
All Cancers
Cancers caused by smoking
Cancers attributable to
smoking
Cancers attributable to
smoking
Attributable percentage
Respiratory Disease
Discharges
Bed days
Costs
All Respiratory Disease (RD)
20,554
182,840
€ 132 million
RD caused by smoking
RD attributable to smoking
10,350
6,417
105,657
60,136
€ 75 million
€ 43 million
Attributable percentage
31.2%
32.9%
32.8%
Female
All Respiratory Disease (RD)
19,365
169,722
€ 117 million
RD caused by smoking
9,026
94,630
€ 65 million
RD attributable to smoking
5,338
50,302
€ 36 million
Attributable percentage
27.6%
29.6%
31.0%
Male
Digestive diseases, Cataracts, Hip # and
Spontaneous Abortion
Male
Other diseases caused by
smoking
Other diseases attributable
to smoking
Attributable percentage
Female
Other diseases caused by
smoking
Other diseases attributable
to smoking
Attributable percentage
Discharges
Bed days
Costs
3,108
11,940
€ 13 million
974
4,917
€ 5 million
31.3%
41.2%
38.5%
5,580
17,474
€ 19 million
1,029
5,027
€ 5 million
18.4%
28.8%
26.3%
Combining males and females
Discharges
CVD attributable to smoking 12,098
Attributable percentage
18.1%
Bed days
97,496
19.1%
Costs
€ 110 million
22.1%
10,400
82,697
€ 81 million
10.9%
17.9%
16.2%
RD attributable to smoking
Attributable percentage
11,755
29.4%
110,438
31.3%
€ 80 million
31.9%
All diseases attributable to
smoking
36,255
300,756
€ 280 million
3.7%
8.7%
9.4%
Cancers attributable to
smoking
Attributable percentage
Attributable percentage
Conclusions
• Smoking attributable diseases place a significant
burden on the acute hospital sector
• In 2008, smoking attributable diseases account for:
– 36,255 discharges
– 300,756 bed days
– € 280 million
• Underscores the necessity to invest in cost effective
prevention measures which would be a fraction of
the above costs.
• Repeat analysis for subsequent years
• Need to quantify all healthcare costs associated with
smoking