Longitudinal trends in firearm related hospitalizations in the United States: profile and outcomes in 2000 to 2008

Transcription

1 Longitudinal trends in firearm related hospitalizations in the United States: profile and outcomes in 2000 to 2008 November 4, 2013 Min Kyeong Lee DMD Veerajalandar Allareddy MD MBA FAAP Sankeerth Rampa BE MBA Romesh Nalliah BDS Veersathpurush Allareddy BDS PhD MBA MMSc

2 Study Context Firearm injuries (FAI) Unintentional injuries, suicides, homicides 1 = 3 leading causes of death in year olds in US 2 Public health issue 3 Plans for firearm law reforms have been proposed 4 National estimates of economic impact of FAI Preventive programs targeted at high risk group Policies pertaining to gun control 1. Hoyert & Xu (2012) 2. National Center for Injury Prevention and Control 10 Leading Causes of Death, United States) 3. Steinbrook & Redberg (2013) 4. Record & Gostin (2013)

3 Objective Provide nationally representative longitudinal estimates of characteristics and outcomes associated with hospitalizations attributed to firearm injuries in the United States during the 2003 to 2010

4 Approach Nationwide Inpatient Sample (NIS) Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality Years 2003 through2010 Case selection: all hospitalizations with firearm related injuries using ICD-9-CM E codes and CCS code

5 ICD-9-CM External Cause of Injury E955.0 E955.1 E955.2 E955.3 E955.4 E922.0 E922.1 E922.2 E922.3 E922.8 E922.9 E928.7 E965.0 E965.1 E965.2 E965.3 E965.4 E970 Description Self-inflicted injury by handgun Self-inflicted injury by shotgun Self-inflicted injury by hunting rifle Self-inflicted injury by military firearms Self-inflicted injury by other and unspecified firearm Accident caused by handgun Accident caused by shotgun (automatic) Accident caused by hunting rifle Accident caused by military firearms Accident caused by other specified firearm missile Accident caused by unspecified firearm missile Other accident cause Assault by handgun Assault by shotgun Assault by hunting rifle Assault by military firearms Assault by other and unspecified firearm Injury due to legal intervention by firearms E979.4 Terrorism involving firearms E985.0 E985.1 E985.2 E985.3 E985.4 Injury by handgun undetermined whether accidentally or purposely inflicted Injury by shotgun undetermined whether accidentally or purposely inflicted Injury by hunting rifle undetermined whether accidentally or purposely inflicted Injury by military firearms undetermined whether accidentally or purposely inflicted Injury by other and unspecified firearm undetermined whether accidentally or purposely inflicted

6 Approach Demographic characteristics Age, sex, race, insurance status, disposition at discharge Type of firearm injury Outcomes: hospitalization charges, length of stay, mortality SAS 9.3 (SAS Institute, Cary, NC)

7 Number of Hospitalizations Hospitalizations with Firearm Injuries in the US Year

8 Number of Hospitalizations Hospitalizations Due To Firearm Injuries in the US, Adolescents & young adults ~79% % % 19% <1 year % % Age Groups % % % % >70

9 Hospitalizations with Firearm Injuries in the US, Female 11% Male 89%

10 Hospitalizations with Firearm Injuries in the US, Asian/Pacific Islanders 1% Hispanic 19% Native Americans 1% Other 4% White 27% Black 48%

11 Hospitalizations with Firearm Injuries in the US, Uninsured 34% Other* 11% Medicare 5% Medicaid 27% Private 23% *Other includes Worker's Compensation, CHAMPUS, CHAMPVA, Title V, and other government programs.

12 Hospitalizations with Firearm Injuries in the US, Discharge against medical advice 2% Home health care 7% Died in hospital 8% Destination unknown 0% Transfer-long term 9% Transfershort term 2% Routine 72% *Transfer to another short term acute care facility + Transfer to other long term facilities ((skilled nursing facilities, intermediate care facilities, and other type)

13 Type of Firearm Injury

14 Cause of Firearm Injury Legal intervention 2% Undetermined 7% Suicide and selfinflicted 8% Accident 22% Assault 61%

15 Type of Firearm Used Handgun 31% Other and unspecified 60% Shotgun 7% Hungting rifle 2% Miliary firearms

16 Hospitalization Charges (2010 US$) Hospitalization Charges for Firearm Injuries in the US $75,884 on average $18.9 billion over Year

17 Length of Stay (Days) 7.6 Length of Stay for FIrearm Injury-Related Hospitalizations in the US days on average 1.8 million over Year

18 In-hospital Mortality (# hospitalizations) 3600 Mortality Among FIrearm Injury-Related Hospitalizations in the US ,355 in-hospital mortality = 8.1% Year

19 Summary of Results Firearm injuries in in the US led to 252,181 hospitalizations 80% adolescents and young adults, ½ in % males 48% Blacks ~1/3 uninsured 61% assault 31% handgun, 7% shotgun, 2% hunting rifle, 60% other and unspecified 7.1 days in hospital on average 1.8 million days total $75,884 mean charges $18.9 billion over 8 8.1% in-hospital mortality = 20,355 deaths over 8

20 Implications FAI, a persistent public health issue in the United States Despite several educational preventive programs over the past decade, high risk profile (adolescents, young adults, males, blacks, uninsured) remained similar Significant utilization of hospital resources $ and days in hospital Years of life lost, disability, lack of productivity, societal well-being, and emotional turmoil is far-reaching Enforce & strengthen existing laws, and highlight preventive interventions targeting high risk individuals

21 Conclusions The current study provides estimates of high risk individuals who are likely to be hospitalized with firearm injuries and hospitalization outcomes associated with such injuries. Firearm related injuries are associated with utilization of considerable amount of hospital resources and present a significant public health issue in the United States.

22 References 1. Hoyert DL, Xu J. Deaths: preliminary data for Natl Vital Stat Rep. 2012;61(6): National Center for Injury Prevention and Control. 10 Leading Causes of Death, United States. 2010, All Races, Both Sexes. Accessed Feb 16th, Steinbrook R, Redberg RF. Firearm Injuries as a Public Health Issue, Editorial. JAMA Intern Med Apr 8;173(7): doi: /jamainternmed Record KL, Gostin LO. A Systematic Plan for Firearms Law Reform. Viewpoint. JAMA Mar 27;309(12): doi: /jama Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project, Nationwide Inpatient Sample year documentation. URL is Date of access is 04/06/2013.