The most obvious cost of gun violence is the loss of life. Each year 40,000 people in the United States are killed by firearms. Less visible are the estimated 85,000 people who survive firearm injuries. In a recent study, a team of Harvard Medical School researchers, including Katherine Koh, MD MSc, a member of the Department of Psychiatry at Mass General and the Boston Health Care for the Homeless Program, examine the medical and financial repercussions of non-fatal firearm injuries.
In this study, the researchers used MarketScan Medicare and commercial claims data (2008 to 2018) to examine changes in health care spending, utilization of health care services, and morbidity in the victims of non-fatal firearm injuries and their family members during the first year after the firearm injury.
Health Care Spending Increased Fourfold in the Year After Firearm Injury
Health care services were examined for 6498 survivors of firearm injuries and a comparison group of 32,490 matched participants. Before firearm injury, healthcare spending averaged $620 per person per month. Medical spending increased by $25,554 during the first month after injury, representing a 41-fold increase in healthcare spending. Over the course of the year, medical spending increased $2495 per person per month (402%) in survivors, compared to uninjured controls. Although 96% of these costs were covered by insurance or Medicare, patient cost sharing increased by $1112 or 19-fold in the month after injury and increased by $102 per month or 176% on average in the year relative to control participants.
Among survivors, the greatest increases in spending, use of healthcare services, and morbidity were observed in victims of intentional firearm injuries and in those with more severe injuries.
Increased Risk of Pain Diagnoses and Psychiatric Illness in Survivors
All categories of health care use increased relative to the control group. During the first year, survivors had increases in office visits (52%), procedures (81%), imaging (161%), home health care (207%), and transportation services (431%).
Survivors had a 40% increase in pain diagnoses, a 51% increase in psychiatric disorders, and an 85% increase in substance use disorders during the year after firearm injury relative to control participants (P < 0.001). accompanied by increased pain and psychiatric medications. In addition, the group looked at healthcare services in 12,489 family members of survivors and 62,445 control participants. Family members had a 12% increase in psychiatric disorders relative to control participants (P = 0.003). The greatest increases in psychiatric morbidity were observed in the victims of intentional firearm injuries and in those with more severe injuries.
Public Health Implications
The authors estimate that after a nonfatal firearm injury, we can expect an additional $30,000 in healthcare spending for the survivor and affected family members. If this $30,000 additional spending per survivor is multiplied by the roughly 85,000 survivors of firearm injuries seen in the US annually, healthcare spending attributable to nonfatal firearm injuries would exceed $2.5 billion each year for new survivors. And this is only the first year after injury; this study does not estimate long-term medical spending associated with traumatic brain injuries, other disabilities, mental health issues, and other clinical consequences of nonfatal firearm injuries. Furthermore, the total economic costs would be even greater if we included indirect costs, such as lost productivity and decreased quality of life.
While the ultimate goal is to reduce gun violence, the authors note that clinicians can help to reduce the long-term impact of gun violence by regularly screening gunshot survivors and their family members for signs of mental health problems, including anxiety, depression, and post-traumatic stress disorder. In addition, clinicians must be mindful of an increased risk of substance use disorders, especially when treating pain in the wake of a firearm injury.
Read More
Song Z, Zubizarreta JR, Giuriato M, Paulos E, Koh KA. Changes in Health Care Spending, Use, and Clinical Outcomes After Nonfatal Firearm Injuries Among Survivors and Family Members : A Cohort Study. Ann Intern Med. 2022 Apr 5.
In the News
The Hidden Cost of Firearm Injuries (Harvard Medical School)
Clinical, Economic Impact of Nonfatal Firearm Injuries Explored (Physician’s Weekly)
Gun Violence Wreaks Havoc on Lives of Survivors, Their Families (HealthDay)
Katherine Koh, MD, MSc is a practicing psychiatrist at Mass General Hospital, a member of the Street Team at the Boston Health Care for the Homeless Program and an Assistant Professor in Psychiatry at Harvard Medical School. As a member of the street team at BHCHP, she focuses her clinical care on homeless patients who live on the street through a combination of street outreach, clinic sessions, and home visits for patients recently or unstably housed. She also maintains a general outpatient practice at MGH and conducts research on the health of homeless populations. Her primary interest is improving systems of mental health care for homeless patients.
