20 May 2022

Nonfatal Firearm Injury Costs

Welcome back. If you follow or occasionally visit this blog, you may be aware that I’ve written about firearms--four times to pitch the need for gun research, not gun control.

As I described in the first of my four posts (see Gun Research), Congress essentially shut down gun research funding by the Centers for Disease Control and Prevention in 1996 and later by the National Institutes of Health. Although research continued without federal support, it was estimated that gun violence research funding and publications were less than 5% of what would have expected based on the statistics for other leading causes of death.

I am happy to note that, in December 2019, Congress changed its collective mind. After more than 20 years, Congress approved funding of $25 million for fiscal 2022 to be split between the CDC and NIH to examine gun violence from a public health perspective. While experts concede the amount is small in comparison to the scope of the issue, they celebrated.

Congress approved fiscal year 2022 funding for the CDC and NIH to examine gun violence (graphic from abcnews.go.com/Politics/decades-long-gap-gun-violence-research-funding-lasting/story?id=80646946).
Which brings me to an example of the gun research that NIH funded.

Long-Term, Often Hidden Costs of Firearm Injuries
Some 45,000 people are killed in the U.S. by firearms each year; more than twice as many sustain firearm injuries and survive.

A team of researchers set out to measure the first year’s changes in clinical and economic outcomes for survivors and their family members after nonfatal firearm injury. These typically include worse mental health, substance use disorders and higher health care spending.

The researchers were affiliated with Harvard Medical School, Massachusetts General Hospital, Harvard T.H. Chan School of Public Health, Harvard University, Michigan University and Boston Health Care for the Homeless Program.

Data for Analysis
The researchers analyzed 10 years of data, 2008-2018, from IBM MarketScan commercial and Medicare claims databases--nationwide samples of employer-sponsored commercial insurance enrollees and Medicare beneficiaries with employer-sponsored Medicare supplemental coverage. The databases contain detailed claims data for more than 40 million persons annually.

They identified two cohorts: survivors of firearm injury and the survivors’ family members, all of whom had been enrolled in the insurance coverage for at least 1 year before through 1 year after the firearm injury. For control, each cohort member was matched to five unexposed participants.

The final dataset comprised 6,498 survivors and 32,490 matched control participants, along with 12,489 family members and 62,445 matched control participants.

About 71% of nonfatal firearm injuries were unintentional; 21% were assaults and 4% self-harm.

Characteristics of firearm injury survivors and their matched control participants. DxCG – Diagnostic Cost Groups risk score is a measure of health status or expected spending; larger values denote greater expected spending. Consumer directed health plans -- preferred-provider organization plans with health reimbursement funded by employer (from Table 1 of www.acpjournals.org/doi/10.7326/M21-2812).
Study Findings
In the first year after injury, the survivors’ medical spending increased 402% per person per month and cost sharing (co-pays and deductibles) increased 176% per person per month over the control participants’ spending. The increase was driven by the first month’s spending of 4,122%  and 1,917% in cost sharing per survivor.

The cost of all categories of the survivors’ health care increased relative to the control participants--40% increase in pain diagnoses, 51% increase in psychiatric disorders and 85% increase in substance-use disorders, in addition to increased pain and psychiatric medications. Family members had a 12% increase in psychiatric disorders relative to their control participants.

These clinical and economic changes were driven by intentional and more severe firearm injuries.

Changes in study outcomes for 1 year after unintentional and intentional nonfatal firearm injuries; intentional firearm injuries include assault, self-harm and law-enforcement shootings (from Table 3 of www.acpjournals.org/doi/10.7326/M21-2812).
Wrap Up
Nonfatal firearm injuries cause survivors, their families, employers, insurers and society to spend thousands of dollars more each month on healthcare. Considering the annual number of gunshot survivors in the U.S., the researchers estimate direct health care spending to be well over $2 billion for just the first year.

The researchers suggest that it might be wise for doctors to screen gunshot survivors and their family members for signs of mental health problems and to be mindful of an increased risk of substance use disorders when treating pain in the wake of a shooting.

Interesting stuff when Congress allows gun research. Thanks for stopping by.

CDC tally of firearm deaths: www.cdc.gov/nchs/fastats/injury.htm
Congressional turnabout on funding CDC and NIH gun violence research:
Study of nonfatal firearm injury outcomes in Annals of Internal Medicine journal: www.acpjournals.org/doi/10.7326/M21-2812
Article on study on EurekAlert! website: www.eurekalert.org/news-releases/948335

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