Cost of hospitalization for firearm injuries by firearm type, intent, and payer in the United States

Injury Epidemiology, Jul 2017

Background Firearm injuries disproportionately affect young, male, non-White populations, causing substantial individual and societal burden. Annual costs for hospitalized firearm injuries have not been widely described, as most previous cost studies have focused on lifetime costs. We examined a nationally-representative database of hospitalizations in the US to estimate per-hospital and overall hospital costs for firearm injuries by intent, type of weapon, and payer source. Methods We conducted a retrospective cohort study of all firearm injury hospitalizations in the National Inpatient Sample from 2003 through 2013. The National Inpatient Sample, maintained by the Healthcare Utilization Project, is a stratified and weighted national sample of more than 20% of all hospitals. All admissions for firearm injuries were identified through Ecodes, yielding a weighted total of 336,785 for the study period. Average annual per-patient and overall hospital costs were estimated using generalized linear modelling, controlling for patient and hospital variables. Costs by intent, firearm type, and payer sources were estimated. Results Annually from 2003 through 2013, 30,617 hospital admissions were for firearm injuries, for an annual rate of 10.1 admissions per 100,000 US population. More than 80% of hospitalizations were among individuals aged 15–44, and rates were nine times higher for males than females and nearly ten times higher for the Black than the White population. More than 60% of admissions were for assaults, and 70% of the injuries that had a known firearm type were from handguns. The average annual admission cost was $622 million. The highest per-admission costs were for injuries from assault weapons ($32,237 per admission) and for legal intervention ($33,462 per admission), but the highest total costs were for unspecific firearm type ($373 million) and assaults ($389 million). A quarter of firearm injury hospitalizations were among the uninsured, yielding average annual total costs of $155 million. Conclusion Hospitals can project that government insurance will be the highest source for firearm injury reimbursement, and depending on healthcare access laws, that many of their firearm injury admissions will not be covered by insurance.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://link.springer.com/content/pdf/10.1186%2Fs40621-017-0120-0.pdf

Cost of hospitalization for firearm injuries by firearm type, intent, and payer in the United States

Peek-Asa et al. Injury Epidemiology Cost of hospitalization for firearm injuries by firearm type, intent, and payer in the United States Corinne Peek-Asa 0 Brandon Butcher 1 Joseph E. Cavanaugh 1 0 The Department of Occupational and Environmental Health, College of Public Health, University of Iowa , 145 North Riverside Drive, S143 CPHB, Iowa City, IA 52242 , USA 1 The Department of Biostatistics, College of Public Health, University of Iowa , Iowa City, Iowa , USA Background: Firearm injuries disproportionately affect young, male, non-White populations, causing substantial individual and societal burden. Annual costs for hospitalized firearm injuries have not been widely described, as most previous cost studies have focused on lifetime costs. We examined a nationally-representative database of hospitalizations in the US to estimate per-hospital and overall hospital costs for firearm injuries by intent, type of weapon, and payer source. Methods: We conducted a retrospective cohort study of all firearm injury hospitalizations in the National Inpatient Sample from 2003 through 2013. The National Inpatient Sample, maintained by the Healthcare Utilization Project, is a stratified and weighted national sample of more than 20% of all hospitals. All admissions for firearm injuries were identified through Ecodes, yielding a weighted total of 336,785 for the study period. Average annual per-patient and overall hospital costs were estimated using generalized linear modelling, controlling for patient and hospital variables. Costs by intent, firearm type, and payer sources were estimated. Results: Annually from 2003 through 2013, 30,617 hospital admissions were for firearm injuries, for an annual rate of 10.1 admissions per 100,000 US population. More than 80% of hospitalizations were among individuals aged 15-44, and rates were nine times higher for males than females and nearly ten times higher for the Black than the White population. More than 60% of admissions were for assaults, and 70% of the injuries that had a known firearm type were from handguns. The average annual admission cost was $622 million. The highest per-admission costs were for injuries from assault weapons ($32,237 per admission) and for legal intervention ($33,462 per admission), but the highest total costs were for unspecific firearm type ($373 million) and assaults ($389 million). A quarter of firearm injury hospitalizations were among the uninsured, yielding average annual total costs of $155 million. Conclusion: Hospitals can project that government insurance will be the highest source for firearm injury reimbursement, and depending on healthcare access laws, that many of their firearm injury admissions will not be covered by insurance. Firearm violence; Hospitalization costs; National sample Background Among all injury deaths in the United States in 2015, 17% were caused by a firearm (National Center for Injury Prevention and Control & US Centers for Disease Control and Prevention, 2015; Karp, 2011) . Among youth aged 15–24 this percent increased to 29.6%, and for Black youth firearms were the leading overall cause of death, resulting in 58.6% of all injury deaths. Individual firearm ownership is high but not unique to the United States, although the burden of firearm violence is: World Health Organization mortality data from 2010 indicate that US gun-related homicide rates were 25 times higher than in a comparison group of 23 high income countries (Cook & Ludwig, 1997; Council on Injury, Violence, and Poison Prevention Executive Committee & American Academy of Pediatrics, 2012; Grinshteyn & Hemenway, 2016) . While the majority of research has been on firearm deaths, the individual, family, and community burden is also high for those with non-fatal firearm injuries. Research to reduce the health and societal burden of firearm injuries has been lacking, and medical and public health groups have published calls to build an evidence base for prevention (Karp, 2011; Branas et al., 2017; Strong et al., 2016) . Understanding the economic burden of firearm injuries is a critical element of advancing our knowledge base. Of seven studies reporting the cost burden of firearm injuries (Salemi et al., 2015; Spitzer et al., 2017; Corso et al., 2007; Lee et al., 2014; Miller, 2012; Fowler et al., 2015; Allareddy et al., 2012) , two have estimated hospitalization costs for firearm injuries in the US population (Salemi et al., 2015; Spitzer et al., 2017) . Salemi et al. (2015) estimated annual hospitalization costs at $679 million and reported hospitalization costs by patient and hospital (Salemi et al., 2015) . Spitzer et al. (2017) estimated total hospitalization costs for the period of 2006–2014 at $6.6 billion and reported costs by payer source (Spitzer et al., 2017) . Neither of these studies conducted multivariable analysis to examine cost components from firearm injuries. Of the other firearm cost studies, three focused on the ov (...truncated)


This is a preview of a remote PDF: https://link.springer.com/content/pdf/10.1186%2Fs40621-017-0120-0.pdf

Corinne Peek-Asa, Brandon Butcher, Joseph E. Cavanaugh. Cost of hospitalization for firearm injuries by firearm type, intent, and payer in the United States, Injury Epidemiology, 2017, pp. 20, Volume 4, Issue 1, DOI: 10.1186/s40621-017-0120-0