Is going to hospital more dangerous than smoking cigarettes?

Is going to hospital more dangerous than smoking cigarettes? 

Are “dirty doctors doing you damage”? 

Actually it is about the same.  I was prompted to think about this by the advertisement below (Australian).  The message is that “every cigarette is doing you damage”.  It is delivered by a “surgeon” doing an operation explaining the diseases that can result from smoking.

The surgeon does not worry about wearing a mask during the operation which made me wonder about how smoking as an activity compares to going to hospital.  Smoking can give you a disease.  Going to hospital can give you hospital-acquired infections (e.g. from this doctor) and problems from other medical errors.  How do they compare?

Smoking kills a lot more people than going to hospital (443,000 v 71,000 in the USA).  But people smoke a lot.  The prospect would be slim that an identifiable level of damage would caused by every one of the 300 billion cigarettes smoked each year.  There is probably a bit of poetic licence in the tagline.  Nevertheless overall it is obviously damaging. A bit of work on the figures from the CDC and the Institute of Medicine report ‘To Err is Human’ reveals that when the exposure is taken into account that the risk of fatality is about the same from either pastime – be it smoking – or being a patient  in a hospital.  It comes to one fatality for about each 60,000 hours exposure. 

Is it actually the same?  Which is worse?  Hard to say without a lot more reseach.  But it is ironic that the advice delivered by the wise doctor contains its own message about the dangers of the “health” system.  I expect this was unintentional – another error!

Image

Image source: http://www.youtube.com/watch?v=80fux1DE1kQ

Fatality rates

Getting the exposure figures right here would really take some doing on both outcomes (fatalities caused) and exposure but here is an approximation based on what seems to be available. 

Fatality rate for smoking

Number of cigarettes and cigars per year = 316 billion

Allow 5 minutes each.

Exposure = 26.3 billion hours

Fatalities = 443,000

Rate = 59,443 hrs exposure / fatality

Fatality rate for hospital errors

Number of inpatient discharges = 36.1 million

Average stay = 4.9 days

Exposure = 4.25 billion hours

Fatalities = 71,000 (taking the average of the Institute of Medicine estimates)

Fatality rate = 59,793 hours exposure / fatality

References:

http://www.cdc.gov/tobacco/data_statistics/fact_sheets/economics/econ_facts/

http://www.cdc.gov/nchs/fastats/hospital.htm

Kohn, L.T., Corrigan, J.M. & Donaldson, M.S. (eds) 2000, To Err is Huma: Building a Safer Health System, Institute of Medicine, National Academy Press, Washington.

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About John Culvenor

Hi, Thank you for taking a look at this blog. I work in engineering, ergonomics, creativity, design, training, etc. Often this is about helping solve legal puzzles through accident analysis. Sometimes it is about thinking up better designs for equipment, workplaces, and systems. This blog is about good design and bad design, accident analysis and how it can be done better, and how we can make a better, safer world by design!
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14 Responses to Is going to hospital more dangerous than smoking cigarettes?

  1. Richard Coleman says:

    John, I’m having dinner tonight with an emergency doctor from the Alfred Hospital. I will be quoting these numbers – it will be great sport.

  2. Hi Richard, Good to hear from you. Here’s a survey for you to do after talking with your friend. See which of these excuses for the medical industry come up: (a) it’s different in Australia, (b) it’s different now, (c) the figures are wrong!

  3. Pingback: Relative risks: driving, smoking, skydiving, stairs or going to hospital. | safedesign

  4. Pingback: Gaza conflict ten times less likely to kill you than a US hospital | safedesign

  5. Congratulations on finding these numbers. I’m sure the excuses will include that your analysis is non-standard. Thank goodness for non-standard analyses.

    One of the comparisons I’m reading talks about probabilities of death without a clear statement of the base case. So, for example, the probability of death from BASE jumping is 9/21000 and was recalculated to 1/2317 jumps (http://www.medicine.ox.ac.uk/bandolier/booth/risk/sports.html). If I take the 9/21000 and calculate 43/100000, I can make a comparison to just sitting and watching TV (xx/100000, presumably the simple average death rate; your time framework looks potentially useful), but arguments about what the behavior comparison was will cloud the issue. Your thoughts?

  6. Hi William,

    Thank you for the feedback.

    Hospital risk: there is a fairly wide acknowledgement of the overall magnitude of the problem but I’ve never seen any other attempt to put a risk figure based on exposure time.

    BASE jumping: Amazingly dangerous. How long does a BASE jump last? I used 5 minutes for skydiving. Is it right? Who knows but it’s not hours or days so let’s say 5 minutes which gives an annual exposure of 105,000 minutes (5×21,000). Or 1750 hours. Giving a figure of only 194 hours exposure for each fatality. This is incredibly dangerous. 82 times more dangerous and parachuting. 9000 times more dangerous than driving a car!

    TV watching: People who want to make some things seem safer will say “more people die watching TV”. Probably true as a total but it only arises due to vastly greater exposure. If all people watching TV spent the time BASE jumping there would be no people left in the country in a short while.

    Smoking: Smoking is not nearly as dangerous per unit exposure as most people think. Because it is such a popular activity with high exposure it results in a high number of deaths from a relatively moderate level of danger.

    • William Hoffman says:

      May I recommend Mark Twa

    • William Hoffman says:

      I got a reply from “donot reply” with a fragment of my earlier response.  Please let me know if the ema

      • Hi William, It looks as though you messages are being cut short. Never seen that before.

      • William Hoffman says:

        John,  I’ve been replying using my ema

      • William Hoffman says:

        My email system gives me an easy place to enter a reply, *but your
        outlined box asks for replying above “this line”, so I am trying this* to
        see if this gets through without truncation. I will also enter it* above
        (in my usual place) and see i*f this gets through, or the other
        does…Bill*  The lower one only has the words.  The upper one also has *****— comment-reply@wordpress.com wrote:From: safedesign <comment-reply@wordpress.com>To: xaxx@basicisp.netSubject: [New comment] Is going to hospital more dangerous than smoking cigarettes?Date: Wed, 4 Feb 2015 01:06:33 +0000My email system gives me an easy place to enter a reply, but your outlined box asks for replying above “this line”, so I am trying this to see if this gets through without truncation. I will also enter it above (in my usual place) and see if this gets through, or the other does…Bill

        William Hoffman commented: “John,  I’ve been replying using my ema”

      • Hi William, It looks like the WordPress sites work better if you reply on the site rather than from the email.

      • Thanks for your several efforts. I will come here in future replies. Thanks again for the basic information.

        Just wanted to add the rest of the comment from Mark Twain, who realized that statistics showed the most dangerous place to be was in bed. http://www.twainquotes.com/Galaxy/187102d.html

  7. William, That is a wonderful piece by Mark Twain!

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