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Financial Burden and Outcomes of Firearm Injuries in U.S. Hospitals, 2003-2020
Gozienna Okeke1, Mahrukh Sana2, Erfan Faridmoayer3
1Harpur College of Arts and Sciences, State University of New York Binghamton University, Binghamton, New York.
Insights
Firearm-related injury costs have risen significantly, particularly for Medicaid patients. These increasing costs disproportionately burden disadvantaged individuals and safety-net hospitals.
Area of Science:
- Public Health
- Health Economics
- Trauma Surgery
Background:
- Firearm-related injuries (FRIs) represent a significant and preventable public health crisis.
- Understanding the financial burden of FRIs is crucial for resource allocation and policy development.
Purpose of the Study:
- To analyze inpatient costs associated with firearm-related injuries.
- To stratify these costs by patient insurance payer type and hospital safety-net mix.
Main Methods:
- Utilized the National Inpatient Sample (NIS) database from 2003-2020.
- Identified FRIs using International Classification of Disease (ICD) diagnosis codes.
- Employed mixed-effects generalized linear regressions to model inflation-adjusted inpatient costs, accounting for hospital-level variations.
Main Results:
- Total inflation-adjusted inpatient costs for FRIs exceeded $15.2 billion.
- Medicaid and self-pay patients accounted for the largest cost burdens ($6.2 billion and $5 billion, respectively).
- Since 2014, FRI incidence declined in self-pay/no-charge patients but rose in Medicaid patients, leading to a 127% increase in Medicaid costs. Costs also rose in safety-net hospitals.
Conclusions:
- The incidence and associated healthcare costs of firearm-related injuries have substantially increased among Medicaid-insured individuals since 2003.
- These escalating costs place a disproportionate financial strain on disadvantaged patient populations and safety-net healthcare facilities.
Introduction:
Firearm-related injuries (FRIs) are serious but a preventable public health issue. The objective of this study was to describe FRI inpatient costs by (1) patient insurance payer type and (2) hospital safety-net mix.
Methods:
FRIs were identified using International Classification of Disease diagnosis codes in the National Inpatient Sample. All admissions between 2003 and 2020 were included. The primary outcome was consumer-price index adjusted inpatient stay costs. Mixed effects generalized linear regressions, with a random intercept at the hospital level, were used to describe costs. Analyses were sample weighted and performed between 2023 and 2024.
Results:
Among 538,795 FRIs, the median age was 27 years (interquartile range: 21-37 years). Injuries by payer type were highest among self-pay (280,161; 39%), followed by Medicaid (182,716; 34%), private (113,650; 21%), and Medicare (30,110; 6%). Inflation-adjusted costs of FRI stays totaled $15.2 billion, with $6.2 billion from Medicaid and $5 billion from the self-pay group. After 2014, FRI incidence declined among self-pay/no-charge patients and increased among Medicaid-covered patients-representing a 127% total increase in Medicaid costs from $169 million in 2003 to $753 million in 2020. Among moderate-high and high safety-net mix hospitals, costs increased from $257 million in 2003 to $567 million in 2020.
Conclusions:
The incidence and costs of FRIs among Medicaid-insured has substantially increased since 2003. Importantly, these increased costs are disproportionately placed on disadvantaged patients and safety-net hospitals.
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