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Gun violence a public health crisis, costs hospitals $2.9 billion a year, reports say

Physicians can play a bigger role by talking to patients about guns in the home, safe removal and storage.

Beth Jones Sanborn, Managing Editor

Following the horrifying and tragic mass shooting in Las Vegas, debates over gun legislation have been revived and once again claims that gun violence is a public health crisis are being stressed by advocacy and academic institutions alike. A recent study from Health Affairs shows firearm-related deaths are the third leading cause of injury-related deaths in the United States, having killed 36,252 people in 2015 alone, and they also levy a $2.9 billion dollar burden on hospitals annually.

Study authors said only motor vehicle accidents and poisonings kill more people each year, but there is limited data on contemporary epidemiological trends and risk factors for firearm-related injuries. Authors used data from the Nationwide Emergency Department Sample of the healthcare Cost and Utilization Project for the period of 2006 to 2014 that showed the incidence of ED visits for firearm related injuries. Firearm deaths that occurred before the victim reached the emergency department, including those who died at the location or committed suicide, or firearm related injuries where the victim didn't go to the hospital were excluded, the study said. The study was approved by the Johns Hopkins Institutional Review Board.

[Also: Hospitals treating high volume of gunshot victims face surge in uncompensated care if ACA is repealed, study says]

From that data, authors identified 150,930 patients, representing a weighted total of 704,916 patients nationally, who presented at the ER during the prescribed period with firearm-related injuries. Such injuries were least common among those 10 years old and younger and highest among those aged 15 to 29 years old, especially ages 20 to 24. Though the age trend was present in both genders, the incidence of firearm-related injuries was roughly ninefold higher in male patients, and that applied overall as well as in particular age groups. The majority of those patients who presented with a firearm injury sustained it in an assault, roughly 49.5 percent, or from unintentional causes, roughly 35 percent. Assault was also the primary driver among those firearm injured patients with medicaid, paid themselves or for whom there was no charge, the study showed.

Handguns were the most commonly used identified firearm.

[Also: ACA repeal could jeopardize crucial Medicaid coverage for gun violence victims]

Of the patients who presented alive to the ED, 48 percent were discharged home, 37.2 percent were admitted to inpatient care and roughly 8 percent died during their ED visit or inpatient admission.

The mean per person ED charges totaled $5,254, while inpatient charges were $95,887. This brought the annual financial burden to approximately $2.9 billion in ED charges and $22 billion in inpatient charges for the study period. The total breaks down to about a $2.9 billion annual burden. Total charges were adjusted for inflation and reported in 2017 dollars.

Uninsured and self-pay patients were at an enormous disadvantage because they lacked negotiating power and leverage with payers, thus they bore the entire financial burden themselves, or the hospital got stuck with the bill, thus inflating the uncompensated care tallies for the hospitals that treated them.

Additionally, it's not just hospital charges that mount as a result of firearm deaths and injuries. For those that live through it, there can be physical therapy, in-home care and trauma counseling needs, not to mention lost income. Because of that, authors said their results likely underestimate the true costs of these injuries. Estimates that attempt to take these other burdens into account swell to $45.6 billion in annual financial burdens resulting from firearm injuries.

Lack of research funding for firearm injuries continues to be a significant challenge as well.

"While gun violence is responsible for about as many deaths as sepsis is, funding for gun violence research is equivalent to .7 percent of the funding allocated for sepsis," authors wrote. "...Only through through the adoption of an evidence-based public health approach can the resulting substantial medical and financial burden be reduced."

An editorial in JAMA once again called out gun violence as a public health crisis, saying that while the focus on tragic mass shootings like Las Vegas tend to pull the country's focus, it is important to remember that almost 100 people die daily from gun violence.

"Since 1968, more individuals in the United States have died from gun violence than in battle during all the wars the country has fought since its inception."

Almost 61 percent of the gun deaths in 2015 alone were suicides.

Authors argued that physicians and other healthcare professionals can do more to combat this devastating issue. Ruled protected speech under the First Amendment, physicians and other medical staff should inquire with their patients about guns in the home, especially for high-risk patients, and offer information and advice on removal and safe storage.

"Good evidence has shown that safe storage of firearms is effective in reducing misuse. Physicians can conduct appropriate screening and early intervention for suicide, the most common cause of gun deaths," authors wrote.

They also pushed for legislative change as a means to combat the public health crisis, including more background checks, heightened security at hotels, schools and events, and additional restrictions on the volume and type of guns that can be legally owned as methods to decrease firearm-related injury and death. "The key to reducing firearm deaths in the United States is to understand and reduce exposure to the cause, just like in any epidemic, and in this case that is guns," authors said.

Twitter: @BethJSanborn
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