Healthcare Costs for Firearms-Related Injuries

Hospitalizations and healthcare costs associated with serious, non-lethal firearm-related violence and injuries in the United States, 1998‐2011

Authors: Salemi, Jason L.; Jindal, Vikas; Wilson, Roneé E.; Mogos, Mulubrhan F.; Aliyu, Muktar H.; Salihu, Hamisu M.

Objective: To describe the prevalence, trends, correlates, and short-term outcomes of inpatient hospitalizations for firearm-related injuries (FRIs) in the United States between 1998 and 2011.

Methods: We conducted a retrospective, cross-sectional analysis of inpatient hospitalizations using data from the Nationwide Inpatient Sample. In addition to generating national prevalence estimates, we used survey logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between FRIs and patient/hospital-level characteristics. Temporal trends were estimated and characterized using joinpoint regression.

Results: There were 10.5 FRIs (95% CI: 9.2‐11.8) per 10,000 non-maternal/neonatal inpatient hospitalizations, with assault accounting for 60.1% of FRIs, followed by unintentional/accidental (23.0%) and intentional/self-inflicted FRIs (8.2%). The highest odds of FRIs, particularly FRIs associated with an assault, was observed among patients 18‐24 years of age, patients 14‐17 years of age, patients with no insurance/self-pay, and non-Hispanic blacks. The mean inpatient length of stay for FRIs was 6.9 days; however, 4.7% of patients remained in the hospital over 24 days and 1 in 12 patients (8.2%) died before discharge. The mean cost of an inpatient hospitalization for a FRI was $22,149, which was estimated to be $679 million annually; approximately two-thirds of the annual cost (64.7%) was for assault ($439 million).

Conclusion: FRIs are a preventable public health issue which disproportionately impacts younger generations, while imposing significant economic and societal burdens, even in the absence of fatalities. Prevention of FRIs should be considered a priority in this era of healthcare cost containment.

Keywords: Assault; cost; gunshot; firearms; hospitalization; intentional injury


Affiliations: 1:Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA 2:Department of Occupational Health, Kaiser Permanente, Lancaster, California, USA 3: Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida, USA 4: Department of Community Health Systems, School of Nursing, Indiana University, Indianapolis, Indiana, USA 5: Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, USA