Firearm-related injuries (FRIs) in the USA are major sources of public health concern. Annually, FRIs result in thousands of deaths and thousands more injuries. In 2013 alone, over 32 000 people in the USA died as a result of FRIs. In 2009 it was estimated that there were 310 million firearms in the USA, not including weapons owned by the military, which is more than one firearm for every citizen. While most of the media and public focus has understandably been on fatalities, less attention has thus far been paid to the economic burdens and costs to the healthcare system associated with non-fatal FRIs.
In the current issue of Family Medicine and Community Health (Volume 3, Number 2, 2015, pp. 8-19(12); DOI: http://dx.doi.org/10.15212/FMCH.2015.0115, researcher Jason Salemi and co-authors from across the USA examine the trends, prevalence and healthcare costs associated with FRI-associated hospitalizations in the USA over the 14-year period from 1998 to 2011.
Their retrospective study revealed some key findings. Significantly, the estimated economic costs of FRIs are immense. The average inpatient length of stay for an FRI was almost 7 days at an average cost of US$22 000. FRIs cost hospitals over US$679 million annually on inpatient care which equates to a staggering US$9 billion over the 14-year study period. This figure does not include direct medical costs for physicians, and indirect costs caused by lost productivity, the costs borne by families and society as a whole or the costs for victims of FRIs that do not attend hospitals.
Despite the declining trends in FRIs observed in the 1990s, that accompanied firearm regulation legislation, this trend did not continue over the 1998-2011 study period. In terms of the documented FRI trends, approximately 60% were associated with assault, 23% were unintentional/accidental, 8% were self-inflicted and 2% were associated with legal intervention. Handguns were implicated in over three quarters of FRIs, with shotguns and hunting rifles responsible for 17.7% and 5.4%, respectively.
A clear urban/rural divide was noted with twice as many FRIs occurring in urban rather than rural settings. Geographical variations were also evident, with the western USA having the highest odds of hospitalization caused by a FRI.
The authors also found that FRIs disproportionately affects the young (18-24 year olds), poor and minority males (Hispanics and Blacks) in urban settings. Although approximately, 60% of all hospitalizations for FRIs were due to assaults, this figure rises to over 70% for Hispanics and Blacks, and rises to over 80% for Hispanic and Black males under 25 years of age in the lowest quartile of household incomes. When compared with the overall proportion of of FRIs that were accidental (23%), unintentional FRIs were particularly common among children under 14 years (almost 50%), Whites (34%) and those residing in rural settings (48%).
Studies such as this by Salemi and colleagues may help to inform and focus firearm regulation legislation and public health prevention measures, and ultimately may help to reduce the overall economic burden of FRIs on the USA healthcare systems.
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Journal
Family Medicine and Community Health