The economic cost of firearm-related injuries in the United States from 2006 to 2010

doi:10.1016/j.surg.2014.02.011

Surgery

Volume 155, Issue 5, May 2014, Pages 894-898

https://doi.org/10.1016/j.surg.2014.02.011 Get rights and content

Background

Estimates of the number of firearm-related injuries widely vary. Although focus has been primarily on deaths, the societal cost of caring for victims of these injuries is largely unknown. Our goal was to estimate the economic impact of nonfatal, firearm-related injuries in the United States based on recent, publically available data.

Methods

We queried several national registries for hospital and emergency department (ED) discharges from 2006 to 2010 to estimate the annual incidence of firearm-related injuries. The cost of direct medical services and lost productivity from firearm-related injuries were extrapolated from recently published estimates. To identify potentially important trends, we compared the economic impact and payor mix for firearm-related injuries in 2006 with those in 2010.

Results

During the 5-year analytic period, we identified 385,769 (SE = 29,328) firearm-related ED visits resulting in 141,914 (SE = 14,243) hospital admissions, costing more than $88 billion (SE = $8.0 billion). Between 2006 and 2010, there was a decrease in the rate of hospital visits from 6.65 per 10,000 visits in 2006 to 5.76 per 10,000 visits in 2010 (P < .001). Similarly, the rate of hospital admissions and ED visits without admission decreased from 2.58 per 10,000 to 1.96 per 10,000 (P < .001) and 4.08 per 10,000 to 3.79 per 10,000 (P < .001). Regression of the economic costs from 2006 to 2010, adjusted for Consumer Price Index, showed no change (P = .15). There was a decrease in the proportion of Uninsured between 2006 and 2010 from 51.6% to 46.78% (P < .001).

Conclusion

Firearm-related injuries are a major economic burden to not only the American health care system but also to American society. The incidence of these injuries has decreased slightly from 2006 to 2010, with no change in the economic burden. Research aimed at understanding the associated financial, social, health, and disability-related issues related to firearm injuries is necessary and would likely enhance our knowledge of the causes of these events, and may accelerate development of interventions and policies to decrease the staggering medical and societal cost of gun violence.

Section snippets

Data source

We queried the Nationwide Inpatient Sample (NIS), the National Emergency Department Sample (NEDS), and the Kid Inpatient Database (KID) from 2006 to 2010 for all hospital and emergency department (ED) discharges for firearm-related injuries based on the International Classification of Diseases version 9 injury codes (E-codes). The following e-codes were used: E922.x, E955.0, E955.x, E965.x, E985.x, E991. The NIS, NEDS, and KID databases are publicly available, nationally representative

Hospital visits for firearm injuries

From 2006 through 2010, there were 385,769 (SE = 29,328) firearm-related ED visits resulting in 141,914 (SE = 14,243) hospital admissions. During this period, 243,856 (SE = 16,677) were seen, evaluated, and were discharged from the ED without need for hospital admission. In 2006, there were 79,834 (SE = 7,189) hospital visits for victims seeking treatment for gunshot wounds. This number steadily decreased to 74,259 (SE = 4,727) by 2010 (Fig 1). This represented a small, but significant,

Discussion

From 2006 to 2010, the cost to care for victims of gunshot violence who presented to the ED is estimated at $88.6 billion. During this period, the number of hospital visits, hospital admissions, and ED visits that did not require admission decreased substantially. The economic cost of victims presenting to the hospital for gunshot violence remained constant between 2006 to 2010. This was in the setting of a decrease in the proportion of victims with no insurance and private insurance, with a

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Cited by (86)

Costs of Fatal and Nonfatal Firearm Injuries in the U.S., 2019 and 2020
2024, American Journal of Preventive Medicine
Firearm-related injuries are among the five leading causes of death for people aged 1–44 years in the U.S. The immediate and long-term harms of firearm injuries pose an economic burden on society. Fatal and nonfatal firearm injury costs in the U.S. were estimated providing up-to-date economic burden estimates.
Counts of nonfatal firearm injuries were obtained from the 2019–2020 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample. Data on nonfatal injury intent were obtained from the National Electronic Injury Surveillance System – Firearm Injury Surveillance System. Counts of deaths (firearm as underlying cause) were obtained from the 2019–2020 multiple cause-of-death mortality data from the National Vital Statistics System. Analyses were conducted in 2023.
The total cost of firearm related injuries and deaths in the U.S. for 2020 was $493.2 billion, a 16 percent increase compared with 2019. There are significant disparities in the cost of firearm deaths in 2019–2020, with non-Hispanic Black people, males, and young and middle-aged groups being the most affected.
Most of the nonfatal firearm injury–related costs are attributed to hospitalization. These findings highlight the racial/ethnic differences in fatal firearm injuries and the disproportionate cost burden to urban areas. Addressing this important public health problem can help ameliorate the costs to our society from the rising rates of firearm injuries.
Pediatric firearm injury related emergency department visits and hospitalizations: a population-based study in the United States
2023, Lancet Regional Health - Americas
Firearm injury (FI) is the leading cause of death in children and adolescents in the United States (US). We describe the epidemiology of pediatric FI-associated emergency department (ED) visits and hospitalizations in the US stratified by race and ethnicity.
Data on pediatric (0–17-year-olds) FI were analyzed using the 2019 Nationwide Emergency Department Sample (NEDS) and Kids’ Inpatient Database (KID), the largest all-payer databases in the US for ED visits and pediatric hospitalizations, respectively. FI encounters were stratified by race and ethnicity. Poisson regression was used to identify factors associated with in-hospital mortality. Sampling weights were applied to generate nationally representative estimates.
There were 7017 pediatric ED visits with FI (NEDS); 85.0% (5961/7017) were male and 73.0% (5125/7017) were adolescents (15–17 years). Overall, 5.5% (384/7017) died in the ED; 53.1% (3727/7017) of ED encounters did not result in hospitalization. There were 2817 pediatric FI hospitalizations (KID); 84.1% (2369/2817) were male and 71.6% (2018/2817) were adolescents; 51.4% (1447/2817) of FI were unintentional, 42.8% (1207/2817) were assault-related, and 5.8% (163/2817) were self-inflicted. Black children had the highest proportion (52.6%; 1481/2817) of hospitalizations among all race and ethnicities (p < 0.0001 vs. White). White children had the highest proportion of hospitalizations for self-inflicted injuries (16.6% [91/551] vs. 4.9% [25/504; p < 0.0001] in Hispanics and 1.7% [24/1481] in Blacks; p < 0.0001). The majority (56.5%; 1591/2817) of hospitalizations were patients from low-income zip codes (median annual-household-income <$44,000); 70% (1971/2817) had Medicaid as the primary insurance payer. Overall, 8.0% (225/2817) died during FI-associated hospitalizations. Self-inflicted injuries had the highest in-hospital mortality (prevalence ratio = 8.20, 95% CI = 6.06–11.10 vs. unintentional).
Black children and children with lower household incomes were disproportionately impacted by FI resulting from assaults and accidents, while White children had the highest proportion of self-inflicted FI injuries. Public health and legal policy interventions are needed to prevent pediatric FI.
US National Institutes of Health.
Association of insurance status with financial toxicity and outcome disparities after penetrating trauma and assault
2023, Surgery (United States)
Financial toxicity, or the impact out-of-pocket medical expenses have on the quality of life, has not been widely enumerated in the trauma literature. We characterized the relationship between insurance status and the risk of financial toxicity after trauma and associated risk factors.
Adults admitted for gunshot wounds, other penetrating injuries, or blunt assault were identified from the 2015 to 2019 National Inpatient Sample. The outcome of interest was a risk of financial toxicity with separate regression models for uninsured and insured populations.
Of an estimated 775,665 patients, 21.2% were at risk of financial toxicity. Patients at risk of financial toxicity were younger, more commonly male, less commonly White, and had a lower Elixhauser Index (Table 1). A higher proportion of uninsured patients were at risk of financial toxicity (40.8% vs 17.7%, P < .001) than insured patients. Whereas the proportion of uninsured patients at risk of financial toxicity significantly increased from 2015 to 2019, it was unchanged in insured patients. After adjustment, non-income demographic and clinical factors were not associated with the risk of financial toxicity amongst the insured. Conversely, the Black or Hispanic race, gunshot wounds, and any in-hospital complications were some factors associated with increased risk of financial toxicity in uninsured patients.
An increasingly larger proportion of uninsured patients are at risk of financial toxicity after trauma. The risk of financial toxicity among the uninsured was more complex than in the insured and associated with race, gunshot wounds, and complications. Increasing insurance access and the adoption of trauma-informed care practices should be used to address financial toxicity in this population.
The Cost of Gunshot Wounds to the Head: An Unevenly Distributed Burden
2023, World Neurosurgery
Despite the significant clinical consequences and socioeconomic costs of gunshot wounds to the head (GSWH), studies examining prehospital risk factors, geospatial patterns, and economic cost are lacking.
A retrospective analysis was performed for patients with GSWH (single or multiple injuries) presenting to the level one Ryder Trauma Center (hospital patients) as well as the Miami-Dade County Medical Examiner (ME) Department, from October 2013 to October 2015. In addition, ME data were queried from the previous decade (2008–2017) to analyze longitudinal trends.
A total of 402 consecutive patients met the inclusion criteria: 297 (74%) presented to the ME and 105 (26%) presented to the hospital. GSWH in our cohort had a case fatality rate of 89%, predominantly affecting males, whites, and individuals who committed suicide, with a mean age of 41.9 ± 20.6 years. Hospital patients were more likely to be black males from low socioeconomic status (SES) regions involved in assault. Older white males were overrepresented in patients attempting and completing suicide and thus comprised a higher percentage of ME cases. Geospatial analysis of hospital patient injury zip codes shows that GSWH are significantly clustered in low-income urban centers with greater poverty rates. In Miami-Dade County, the economic burden of GSWH, as measured by total health care costs and lifetime productivity losses, was estimated to be $11,867,415 and $246,179,498, respectively.
In the first analysis of GSWH with the inclusion of both hospital and ME data in a representative urban setting, our findings show prehospital risk factors and the unequal distribution of the significant economic costs of GSWH.
The Economic Impact of Acute Firearm Injuries at a Trauma Center in New Orleans
2023, American Journal of Preventive Medicine
The objective of this study was to examine the payer mix and the economic impact of acute firearm injuries at a Level I Trauma Center in New Orleans.
Acute firearm injury economic data were obtained from the trauma registry database of the University Medical Center in New Orleans, Louisiana for 2016 through 2019. Patients were identified by the ICD-10-CM external causes of morbidity codes found in their electronic medical records. All patients with codes for initial encounters for gunshot wounds were included. Abstracted data included total charges and payments. Using the hospital cost-to-charge ratio, the estimated costs and losses were tabulated. Data analysis for this study occurred from 2020 to 2021.
A total of 2,094 patients with acute firearm injuries were identified over the 4-year period. These patients incurred charges of $122,440.642, whereas $17,293,655 was collected as payment. The estimated cost associated with the encounters was $37,602,667, resulting in a net loss of $20,309,012 from 2016 to 2019 for the hospital.
Firearm injuries continue to plague the U.S. as a serious public health problem, causing preventable death, illness, and disability. They also continue to result in a major economic burden.
Emergency department visit patterns in the recently discharged, violently injured patient: Retrospective cohort review
2023, American Journal of Surgery
Citation Excerpt :
These figures likely represent the institution's choice of emergency department facility fee and include few if any tests or interventions. Nonetheless, ED care is significantly more costly compared to other sources of care both in time and resource utilization.1,13,14 While preventing individual low-cost visits may be seen as having little utility in cost savings for a hospital system, unnecessary ED visits utilize valuable time and resources that could be focused on sicker patients.
Analysis of the costs associated with emergency department (ED) visits after discharge for violent injury could highlight subgroups for the development of cost-effective interventions to support healing and prevent treatment failures in violently injured patients.
A retrospective cohort review was conducted of all patients with return ED visits within 90 days of discharge after treatment for a violent injury occurring between July 1, 2016, and June 30, 2018. Hospital costs were calculated for each incidence and analyzed against demographic and injury type variables to identify trends.
218 return ED visits were identified. Hospital costs showed a high frequency of low-cost visits. For more complex visits, distinct cost patterns were observed for Black and LatinX males compared to White males as a function of age.
Analysis of hospital cost per visit identified trends among different subgroups. Underlying etiologies presumably vary between groups, but hypothesis-driven further investigation and needs assessment is required. Understanding the driving forces behind these cost trends may aid in developing effective interventions.

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Original CommunicationThe economic cost of firearm-related injuries in the United States from 2006 to 2010

Background

Methods

Results

Conclusion

Section snippets

Data source

Hospital visits for firearm injuries

Discussion

Data & statistics (WISQARS)

The Cost of Firearm Violence

The cost of hospitalization for firearm injuries

JAMA

Shooting in the dark: estimating the cost of firearm injuries

Health Affairs

Original Communication
The economic cost of firearm-related injuries in the United States from 2006 to 2010