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Firearm Injuries Increase Individuals’ Healthcare Usage and Costs by as Much as 20-fold Firearm Injuries Increase Individuals’ Healthcare Usage and Costs by as Much as 20-fold

(Reuters Health) – In the six months after a firearm injury, a patient’s health care costs can increase from 3- to 20-fold when compared with the six months prior to the injury, a new U.S. study suggests.

In an analysis of data from more than 2,000 patients who had been shot, researchers found that when patients were injured severely enough to be hospitalized health care costs over a six month period rose by more than 2,000% over what they had been in the previous six months, according to the analysis published in the Annals of Internal Medicine.

This underscores the need for society to address the underlying determinants of firearm injuries, said study coauthor Dr. Megan Ranney, an associate professor of emergency medicine at Brown University in Providence, Rhode Island, and chief research officer at AFFIRM, a network of healthcare and public health professionals combatting gun violence.

“This highlights the fact that this doesn’t have to be a partisan issue,” Dr. Ranney said. “It affects people throughout the United States, all of us. We can decrease the costs significantly if we use the same strategies we used to reduce car crash deaths.”

To take a closer look at health care costs related to firearm injuries, Dr. Ranney and her colleagues turned to data from the five Blue Cross Blue Shield states under the Health Care Service Corporation umbrella: Texas, Illinois, Oklahoma, New Mexico and Montana.

In their analysis, the researchers focused on all members of the insurance group who had an emergency department or hospital visit for an index firearm injury between January 1, 2015 and December 31, 2017. Excluded were patients who had a firearm-related diagnosis in the prior year.

Overall, 2,019 members, representing 19,440 claims, had an index ED or hospital visit for a firearm injury during the study period. A numerically greater proportion of members with firearm injuries were adolescents or young adults, lived in large urban or noncore areas, were African American, had low educational attainment and how lower income as measured by percentage of the federal poverty level.

Total health care costs for ED visits for patients with index firearm injuries discharged from the ED were $18,158,786 (an average of $5,686 per member). Total health care costs for the hospital admission, inclusive of an ED visit, for patients with index firearm injuries requiring a hospital stay were $41,255,916 (an average of $70,644 per member).

Compared with the six months prior to the index injury, the costs for those who were discharged from the ED rose by 347%, while the costs for those who were hospitalized rose by 2,138%.

Some of these injuries, and their costs to the healthcare system, could be prevented by screening for depression and domestic violence, Dr. Ranney said.

The study “reinforces a lot of what we knew about the heavy costs of gun violence in the United States,” said Charles Branas, a professor and department chair of epidemiology at Columbia University’s Mailman School of Public Health in New York City. “This is only a portion of the costs. Beyond the medical system there are also enormous costs, whether it’s to the broader public safety system or societal costs, including the pain and suffering of those affected and their families.”

Beyond that, there are costs to the people who witnessed or heard about the shooting, Branas said. “After hearing or reading about a shooting on the news, some might move away and change the entire economic structure of a city,” he added. “There can be a massive ripple effect.”

There are solutions, Branas said, pointing to a program called Operation Peacemaker implemented in Richmond, California. The program’s combination of job training, substance abuse treatment, mentorship and a stipend of as much as a $1,000 per month to those most likely to be involved in gun violence has been found to cut gun injuries and deaths by more than half, he noted, citing a 2019 study in the American Journal of Public Health (https://bit.ly/30dO8jK).

Another strategy involves fixing up abandoned buildings and turning empty lots into parks, Branas said.

A third way to reduce gun injuries and deaths is to identify people at risk of suicide and temporarily take away their firearms, Branas said. “If you can take away the means, the very lethal means, from people for a temporary period of time you can reduce the risk,” he added.

SOURCE: https://bit.ly/30eY5xz Annals of Internal Medicine, online September 28, 2020.