Smoking related discharges, bed days and costs in the acute hospital sector

Smoking related discharges, bed days and costs in the acute hospital sector

Dr Fenton HowellHSE 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 FemaleCurrent Ex-smoker Current Ex-smoker

35+ yrs 25.8 29.9 23.6 18.945+ yrs 20.8 34.8 21.6 19.6

35-54 yrs 31.2 24.7 29.4 18.055-64 yrs 20.2 32.6 21.7 18.665-74 yrs 18.0 39.9 11.8 21.475+ yrs 14.1 43.5 14.1 20.5

35-64 yrs 28.2 26.8 27.3 18.265+ yrs 16.5 41.2 12.8 21.0

Cancers caused by smoking. Internationally used relative risks

Males Females

Cancers caused by smoking Current RR Ex RR

Current RR Ex 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

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 %

Males FemalesLip, oral cavity, pharynx 76.6% 54.7%Oesophagus 71.6% 65.9%Stomach 28.0% 12.7%Pancreas 27.7% 28.5%Larynx 83.6% 78.4%Trachea, Bronchus, Lung 88.9% 77.4%Cervix Uteri 0.0% 14.2%Kidney and Renal Pelvis 37.4% 10.2%Urinary bladder 47.7% 31.3%Mal Neoplasm, unspec site 57.0% 25.4%Myeloid Leukaemia 24.6% 9.4%

CVD caused by smoking: attributable %

Age Males Females

Ischaemic Heart Dis 35-54 55.5% 60.8%



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 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

Male

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 65,888 € 79 million

Attributable percentage 21.7% 23.0% 25.7%

Female

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 31,608 € 30 million


Cancers

Discharges Bed days CostsMaleAll Cancers 46,123 237,080 € 254 millionCancers caused by smoking 11,877 88,047 € 94 millionCancers attributable to smoking 6,948 55,805 € 55 million


FemaleAll Cancers 49,398 224,113 €248 million

Cancers caused by smoking 8,305 60,196 € 62 million

Cancers attributable to smoking 3,452 26,892 € 26 million


Respiratory Disease

Discharges Bed days CostsMaleAll Respiratory Disease (RD) 20,554 182,840 € 132 millionRD caused by smoking 10,350 105,657 € 75 millionRD attributable to smoking 6,417 60,136 € 43 millionAttributable percentage 31.2% 32.9% 32.8%

FemaleAll Respiratory Disease (RD) 19,365 169,722 € 117 millionRD caused by smoking 9,026 94,630 € 65 millionRD attributable to smoking 5,338 50,302 € 36 million


Digestive diseases, Cataracts, Hip # and Spontaneous Abortion

Discharges Bed days Costs

MaleOther diseases caused by smoking 3,108 11,940 € 13 million

Other diseases attributable to smoking 974 4,917 € 5 million


FemaleOther diseases caused by smoking 5,580 17,474 € 19 million

Other diseases attributable to smoking 1,029 5,027 € 5 million


Combining males and females

Discharges Bed days CostsCVD attributable to smoking 12,098 97,496 € 110 millionAttributable percentage 18.1% 19.1% 22.1%

Cancers attributable to smoking 10,400 82,697 € 81 million


RD attributable to smoking 11,755 110,438 € 80 millionAttributable percentage 29.4% 31.3% 31.9%

All diseases attributable to smoking 36,255 300,756 € 280 million


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

Smoking related discharges, bed days and costs in the acute hospital sector

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