Hospital Costs and Fatality Rates of Traumatic Assaults by Mechanism in the US, 2016-2018

Luke E Barry, Grainne E Crealey, Nga T Q Nguyen, Thomas G Weiser, Sarabeth A Spitzer, Ciaran O'Neill

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Importance: Estimates of the total economic cost of firearm violence are important in drawing attention to this public health issue; however, studies that consider violence more broadly are needed to further the understanding of the extent to which such costs can be avoided.

Objectives: To estimate the association of firearm assaults with US hospital costs and deaths compared with other assault types.

Design, Setting, and Participants: The 2016-2018 US Nationwide Emergency Department Sample and National Inpatient Sample, Healthcare Cost and Utilization Project were used in this cross-sectional study of emergency department (ED) and inpatient admissions for assaults involving a firearm, sharp object, blunt object, or bodily force identified using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes. Differences in ED and inpatient costs (2020 US dollars) across mechanisms were estimated using ordinary least-squares regression with and without adjustments for year and hospital, patient, and injury characteristics. The Centers for Disease Control and Prevention underlying cause of death data were used to estimate national death rates and hospital case-fatality rates across mechanisms. Cost analysis used a weighted sample. National death rates and hospital case-fatality rates used US resident death certificates, covering 976 million person-years. Hospital case-fatality rates also used nationally weighted ED records covering 2.7 million admissions. Data analysis was conducted from March 1, 2021, to March 31, 2022.

Exposure: The primary exposure was the mechanism used in the assault.

Main Outcomes and Measures: Emergency department and inpatient costs per record. National death rates and hospital case-fatality rates.

Results: Overall, 2.4 million ED visits and 184 040 inpatient admissions for assault were included. Across all mechanisms, the mean age of the population was 32.7 (95% CI, 32.6-32.9) years in the ED and 36.4 (95% CI, 36.2-36.7) years in the inpatient setting; 41.9% (95% CI, 41.2%-42.5%) were female in the ED, and 19.1% (95% CI, 18.6%-19.6%) of inpatients were female. Most assaults recorded in the ED involved publicly insured or uninsured patients and hospitals in the Southern US. Emergency department costs were $678 (95% CI, $657-$699) for bodily force, $861 (95% CI, $813-$910) for blunt object, $996 (95% CI, $925-$1067) for sharp object, and $1388 (95% CI, $1254-$1522) for firearm assaults. Corresponding inpatient costs were $14 702 (95% CI, $14 178-$15 227) for bodily force, $17 906 (95% CI, $16 888-$18 923) for blunt object, $19 265 (95% CI, $18 475-$20 055) for sharp object, and $34 949 (95% CI, $33 654-$36 244) for firearm assaults. National death rates per 100 000 were 0.04 (95% CI, 0.03-0.04) for bodily force, 0.03 (95% CI, 0.03-0.03) for blunt object, 0.54 (95% CI, 0.52-0.55) for sharp object, and 4.40 (95% CI, 4.36-4.44) for firearm assaults. Hospital case fatality rates were 0.01% (95% CI, 0.009%-0.012%) for bodily force, 0.05% (95% CI, 0.04%-0.06%) for blunt object, 1.05% (95% CI, 1.00%-1.09%) for sharp object, and 15.26% (95% CI, 15.04%-15.49%) for firearm assaults. In regression analysis, ED costs for firearm assaults were 59% to 99% higher than costs for nonfirearm assaults, and inpatient costs were 67% to 118% higher.

Conclusions and Relevance: The findings of this study suggest that it may be useful for policies aimed at reducing the costs of firearm violence to consider violence more broadly to understand the extent to which costs can be avoided.

Original languageEnglish
Article numbere2218496
JournalJAMA Network Open
Issue number6
Publication statusPublished - 24 Jun 2022


  • violence
  • firearm
  • cost
  • assault


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