The study looked at the costs of assaults for four mechanisms; unarmed or bodily force, using blunt or sharp objects, and firearms, over two years, from 2016 to 2018. They considered two financial measures, emergency department and inpatient costs, and two mortality measures, the national death rate (NDR) from these assaults and the hospital case-fatality rates (HCFR). HCFR reflects deaths while hospitalized; NDR includes all deaths “at the scene” in the ED and hospital. The data comes from a variety of sources, including “the US Nationwide Emergency Department Sample (NEDS) and National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality discharge data.” [1]
The researchers identified 2.8 million ED encounters and roughly 197,000 inpatient admissions (about 7% of the total ED encounters) for assaults. Slightly fewer ED and inpatient records were used to calculate costs and hospital mortality, the HCFRs.
- Females were involved in 42% of ED cases and 19% of inpatient admissions making males the significant players here
- Roughly 18% had private insurance; the remainder were relatively evenly divided between having no insurance or having Medicaid or Medicare. We, the taxpayers pick up 80% of the bills; we, the insured, pick up the rest through our premiums
- The Southern US [2] accounted for 43% or more (55% for firearms) of these cases. For context, the South is our most populous region accounting for 37% of our population – but in every instance, the South had more assaults per capita. The West is the lowest.
Emergency Department Visits
- For women, most assaults involve bodily force; they are beaten (46.5%), firearms are responsible for 12.5%, and blunt and sharp objects in between.
- For men, 53% involved physical force, 87.5% firearms, and sharp and blunt objects as the means of assault were in between.
- Bodily force resulted in the fewest number of hospital admissions, roughly 20%; for assaults with firearms, that percentage rose to 50%.
In Patient Hospitalization
Bodily assault puts more women in the hospital than any other mechanism. It was the least frequent for men; while the other three, blunt and sharp objects and firearms, were roughly the same, guns again were at the top of the list.
“Fun facts” – bodily harm usually involved the head and neck or multiple sites, especially the extremities. For firearms, most injuries were to the extremities or multiple sites. “In the inpatient setting, most bodily force (48%) and blunt object (41%) assaults involved patients who were White, and most sharp object (37%) and firearm (60%) assaults involved patients who were Black.”
There was no data on ED mortality, but deaths while hospitalized for these assaults, their case-fatality rates, and the national death rates per 100,000 US population vary.
As I said, firearms are a very efficient mechanism for mayhem. As to cost
Firearm assaults are also the most costly. We can multiply these costs by the number of cases, and you will find that bodily force, by far and away the most frequent mechanism of assault, is responsible for the greatest costs.
From another cost perspective, bodily force assaults cost roughly half of firearm assaults. Same for blunt objects, ~55%, and sharp object assaults, ~62%.
My calculation of the total for these two years was about $5.620 billion.
The researchers sought only to inform policy decisions with data on the healthcare costs of assaults, especially those from firearms.
“… policies targeting firearm violence may present a cost-effective option in terms of reducing both mortality and health care costs from violence, especially for individuals of lower socioeconomic status and those of Black race. However, political partisanship may slow progress even when there is broad support across party lines for gun control policies at the mass level.”
Why the emphasis on firearms? Firearms generate the greatest amount of downstream costs. I am open to suggestions on how we can reduce bodily harm other than court-ordered restraining orders, the same type of policing that is pooh-poohed when we call them red-flag orders. The floor is now open for debate and comment.
[1] “Suicide, unintentional, undetermined, and legal intervention injuries were excluded….”
[2] “As defined by the U.S. federal government, it includes Alabama, Arkansas, Delaware, the District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.”
Source: Hospital Costs and Fatality Rates of Traumatic Assaults by Mechanism in the US, 2016-2018 JAMA Network Open DOI: 10.1001/jamanetworkopen.2022.18496
Chuck Dinerstein, MD, MBA
Director of Medicine
Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.
