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Published on: January 8, 2020
Changes in Health Care Spending, Use, and Clinical Outcomes After Nonfatal Firearm Injuries Among Survivors and
Zirui Song1, José R Zubizarreta2, Mia Giuriato3
1Department of Health Care Policy, Harvard Medical School and Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (Z.S.).
Background:
Despite increasing awareness of firearm-related deaths, evidence on the clinical and economic implications of nonfatal firearm injuries is limited.
Objective:
To measure changes in clinical and economic outcomes after nonfatal firearm injuries among survivors and their family members.
Design:
Cohort study.
Setting:
MarketScan Medicare and commercial claims data, 2008 to 2018.
Participants:
6498 survivors of firearm injuries matched to 32 490 control participants and 12 489 family members of survivors matched to 62 445 control participants.
Intervention:
Exposure to nonfatal firearm injury as a survivor or family member of a survivor.
Measurements:
Changes in health care spending, use, and morbidity from preinjury through 1 year postinjury relative to control participants, on average and by type and severity of firearm injury.
Results:
After nonfatal firearm injury, medical spending increased $2495 per person per month (402%) and cost sharing increased $102 per person per month (176%) among survivors relative to control participants (P < 0.001) in the first year after injury, driven by an increase in the first month of $25 554 (4122%) in spending and $1112 (1917%) in cost sharing per survivor (P < 0.001). All categories of health care use increased relative to the control group. Survivors had a 40% increase in pain diagnoses, a 51% increase in psychiatric disorders, and an 85% increase in substance use disorders after firearm injury relative to control participants (P < 0.001), accompanied by increased pain and psychiatric medications. Family members had a 12% increase in psychiatric disorders relative to their control participants (P = 0.003). These overall clinical and economic changes were driven by intentional firearm injuries and more severe firearm injuries.
Limitation:
Precision of diagnostic codes and generalizability to other patient populations, including Medicaid and uninsured patients.
Conclusion:
In survivors, nonfatal firearm injuries led to increases in psychiatric disorders, substance use disorders, and pain diagnoses, alongside substantial increases in health care spending and use. In addition, mental health worsened among family members.
Primary Funding Source:
National Institutes of Health.
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