Costs of Fatal and Nonfatal Firearm Injuries in the U.S., 2019 and 2020.

INTRODUCTION: Firearm-related injuries are among the five leading causes of death for people aged 1-44 years in the U.S. The immediate and long-term harms of firearm injuries pose an economic burden on society. Fatal and nonfatal firearm injury costs in the U.S. were estimated providing up-to-date economic burden estimates. METHODS: Counts of nonfatal firearm injuries were obtained from the 2019-2020 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample. Data on nonfatal injury intent were obtained from the National Electronic Injury Surveillance System - Firearm Injury Surveillance System. Counts of deaths (firearm as underlying cause) were obtained from the 2019-2020 multiple cause-of-death mortality data from the National Vital Statistics System. Analyses were conducted in 2023. RESULTS: The total cost of firearm related injuries and deaths in the U.S. for 2020 was $493.2 billion, a 16 percent increase compared with 2019. There are significant disparities in the cost of firearm deaths in 2019-2020, with non-Hispanic Black people, males, and young and middle-aged groups being the most affected. CONCLUSIONS: Most of the nonfatal firearm injury-related costs are attributed to hospitalization. These findings highlight the racial/ethnic differences in fatal firearm injuries and the disproportionate cost burden to urban areas. Addressing this important public health problem can help ameliorate the costs to our society from the rising rates of firearm injuries.

Economic Cost of Injury - United States, 2019.

Unintentional and violence-related injuries, including suicide, homicide, overdoses, motor vehicle crashes, and falls, were among the top 10 causes of death for all age groups in the United States and caused nearly 27 million nonfatal emergency department (ED) visits in 2019.*,† CDC estimated the economic cost of injuries that occurred in 2019 by assigning costs for medical care, work loss, value of statistical life, and quality of life losses to injury records from the CDC's Web-based Injury Statistics Query and Reporting System (WISQARS).§ In 2019, the economic cost of injury was $4.2 trillion, including $327 billion in medical care, $69 billion in work loss, and $3.8 trillion in value of statistical life and quality of life losses. More than one half of this cost ($2.4 trillion) was among working-aged adults (aged 25-64 years). Individual persons, families, organizations, communities, and policymakers can use targeted proven strategies to prevent injuries and violence. Resources for best practices for preventing injuries and violence are available online from CDC's National Center for Injury Prevention and Control.¶.

Average lost work productivity due to non-fatal injuries by type in the USA.

OBJECTIVE: To estimate the average lost work productivity due to non-fatal injuries in the USA comprehensively by injury type. METHODS: The attributable average number and value of lost work days in the year following non-fatal emergency department (ED)-treated injuries were estimated by injury mechanism (eg, fall) and body region (eg, head and neck) among individuals age 18-64 with employer health insurance injured 1 October 2014 through 30 September 2015 as reported in MarketScan medical claims and Health and Productivity Management databases. Workplace, short-term disability and workers' compensation absences were assessed. Multivariable regression models compared lost work days among injury patients and matched controls during the year following injured patients' ED visit, controlling for demographic, clinical and health insurance factors. Lost work days were valued using an average US daily market production estimate. Costs are 2015 USD. RESULTS: The 1-year per-person average number and value of lost work days due to all types of non-fatal injuries combined were approximately 11 days and US$1590. The range by injury mechanism was 1.5 days (US$210) for bites and stings to 44.1 days (US$6196) for motorcycle injuries. The range by body region was 4.0 days (US$567) for other head, face and neck injuries to 19.8 days (US$2787) for traumatic brain injuries. CONCLUSIONS AND RELEVANCE: Injuries are costly and preventable. Accurate estimates of attributable lost work productivity are important to monitor the economic burden of injuries and help to prioritise cost-effective public health prevention activities.

Washington's privatization of liquor: effects on household alcohol purchases from Initiative 1183.

BACKGROUND AND AIMS: Washington Initiative 1183 (I-1183), a 2012 law that privatized liquor retail sales and distribution in Washington State, USA, has had two opposing effects on liquor purchases: it has increased access to liquor and imposed new fees on retailers and distributors. This study aimed to estimate the effect of I-1183 on monthly alcohol purchases during the post-I-1183 period (June 2012-December 2014) compared with the pre-I-1183 period (January 2010-May 2012). DESIGN: DIFFERENCES-IN-DIFFERENCES STUDY: Setting and participants The study included households participating in the Nielsen Consumer Panel Dataset living in metropolitan and surrounding areas in Washington State and 10 control states. Measurements Outcomes were alcohol purchases by type (ounces of liquor, wine, beer and total alcohol or ethanol). Findings I-1183 was associated with a 6.34-ounce (P < 0.001) and a 2.01-ounce (P < 0.001) increase in monthly liquor and ethanol purchases, respectively, per household in the post-policy period spanning 31 months compared with monthly purchases in control states. In a longitudinal subgroup analysis, low and moderate alcohol purchasers increased monthly purchases of ethanol and high purchasers decreased purchases of ethanol. Conclusions Enacting 'Washington Initiative 1183', a law that privatized sale and distribution of liquor and imposed new fees on retailers and distributors, appears to have been associated with an approximate 82% increase in monthly liquor purchases and 26% increase in monthly ethanol purchases by households in metropolitan and surrounding areas in Washington State, USA.

Price Changes in Washington Following the 2012 Liquor Privatization: An Update Through 2016 With Comparisons to California, Idaho, and Oregon.

BACKGROUND: Washington State ended their wholesale and retail monopoly on liquor on June 1, 2012, resulting in a 5-fold increase in liquor outlets in diverse store types. The legislation also included taxes at the wholesale and retail levels. This study seeks to investigate whether prices have changed from 2014 through 2016, as a follow-up to a previous study finding increases in prices from 2012 to 2014, compared to prices in other states. METHODS: We developed an index of 68 brands that were popular in Washington in early 2012. Data on final liquor prices (including taxes) in Washington and California were obtained through store visits and online sources between November 2013 and March 2014, and again between April and May 2016 for Washington only. Pricing data for Idaho and Oregon were obtained from the Statistics for Alcohol Management Database over both sampling periods. Primary analyses were conducted on the utmost brands available in the majority of the stores sampled. RESULTS: Liquor prices in Washington rose an average of 3.9% for 750 ml and 6.5% for 1.75-l containers overall from 2014 to 2016, while bordering states Idaho (+2.9%) and Oregon (+1.5%) experienced smaller increases for 750-ml and declines for 1.75-l containers (Idaho: -2.9%, Oregon: -4.9%). In the analyses of spirits prices in Washington compared to California, prices in California were 24.1% lower for 750-ml containers and 29.6% lower for 1.75-l containers. CONCLUSIONS: Our findings indicate liquor prices in Washington have increased since our 2014 assessment at a larger percentage than prices in the neighboring control states Oregon and Idaho, with varying effects on brands, container sizes, and store types. We demonstrate privatization is associated with a different pattern of prices across store types than seen in California.

Exploring policies for the reduction of child physical abuse and neglect.

Policies can be powerful tools for prevention given their potential to affect conditions that can improve population-level health. Given the dearth of empirical research on policies' impacts on child maltreatment, this article (a) identifies 37 state policies that might have impacts on the social determinants of child maltreatment; (b) identifies available data sources documenting the implementation of 31 policies; and (c) utilizes the available data to explore effects of 11 policies (selected because they had little missing data) on child maltreatment rates. These include two policies aimed at reducing poverty, two temporary assistance to needy families policies, two policies aimed at increasing access to child care, three policies aimed at increasing access to high quality pre-K, and three policies aimed at increasing access to health care. Multi-level regression analyses between within-state trends of child maltreatment investigation rates and these 11 policies, controlling for states' childhood poverty, adults without a high school diploma, unemployment, child burden, and race/ethnicity, identified two that were significantly associated with decreased child maltreatment rates: lack of waitlists to access subsidized child care and policies that facilitate continuity of child health care. These findings are correlational and are limited by the quality and availability of the data. Future research might focus on a reduced number of states that have good quality administrative data or population-based survey data on child maltreatment or reasonable proxies for child maltreatment and where data on the actual implementation of specific policies of interest can be documented.

Economic value of home-based, multi-trigger, multicomponent interventions with an environmental focus for reducing asthma morbidity a community guide systematic review.

CONTEXT: A recent systematic review of home-based, multi-trigger, multicomponent interventions with an environmental focus showed their effectiveness in reducing asthma morbidity among children and adolescents. These interventions included home visits by trained personnel to assess the level of and reduce adverse effects of indoor environmental pollutants, and educate households with an asthma client to reduce exposure to asthma triggers. The purpose of the present review is to identify economic values of these interventions and present ranges for the main economic outcomes (e.g., program costs, benefit-cost ratios, and incremental cost-effectiveness ratios). EVIDENCE ACQUISITION: Using methods previously developed for Guide to Community Preventive Services economic reviews, a systematic review was conducted to evaluate the economic efficiency of home-based, multi-trigger, multicomponent interventions with an environmental focus to improve asthma-related morbidity outcomes. A total of 1551 studies were identified in the search period (1950 to June 2008), and 13 studies were included in this review. Program costs are reported for all included studies; cost-benefit results for three; and cost-effectiveness results for another three. Information on program cost was provided with varying degrees of completeness: six of the studies did not provide a list of components included in their program cost description (limited cost information), three studies provided a list of program cost components but not a cost per component (partial cost information), and four studies provided both a list of program cost components and costs per component (satisfactory cost information). EVIDENCE SYNTHESIS: Program costs per participant per year ranged from $231-$14,858 (in 2007 U.S.$). The major factors affecting program cost, in addition to completeness, were the level of intensity of environmental remediation (minor, moderate, or major), type of educational component (environmental education or self-management), the professional status of the home visitor, and the frequency of visits by the home visitor. Benefit-cost ratios ranged from 5.3-14.0, implying that for every dollar spent on the intervention, the monetary value of the resulting benefits, such as averted medical costs or averted productivity losses, was $5.30-$14.00 (in 2007 U.S.$). The range in incremental cost-effectiveness ratios was $12-$57 (in 2007 U.S.$) per asthma symptom-free day, which means that these interventions achieved each additional symptom-free day for net costs varying from $12-$57. CONCLUSIONS: The benefits from home-based, multi-trigger, multicomponent interventions with an environmental focus can match or even exceed their program costs. Based on cost-benefit and cost-effectiveness studies, the results of this review show that these programs provide a good value for dollars spent on the interventions.

Costs of asthma in the United States: 2002-2007.

BACKGROUND: The economic burden of asthma is an important measure of the effect of asthma on society. Although asthma is a costly illness, the total cost of asthma to society has not been estimated in more than a decade. OBJECTIVE: The purpose of this study is to provide the public with current estimates of the incremental direct medical costs and productivity losses due to morbidity and mortality from asthma at both the individual and national levels for the years 2002-2007. METHODS: Data came from the Medical Expenditure Panel Survey. Two-part models were used to estimate the incremental direct costs of asthma. The incremental number of days lost from work and school was estimated by negative binomial regressions and valued following the human capital approach. Published data were used to value lives lost with an underlying cause of asthma. RESULTS: Over the years 2002-2007, the incremental direct cost of asthma was $3,259 (2009 dollars) per person per year. The value of additional days lost attributable to asthma per year was approximately $301 for each worker and $93 for each student. For the most recent year available, 2007, the total incremental cost of asthma to society was $56 billion, with productivity losses due to morbidity accounting for $3.8 billion and productivity losses due to mortality accounting for $2.1 billion. CONCLUSION: The current study finds that the estimated costs of asthma are substantial, which stresses the necessity for research and policy to work toward reducing the economic burden of asthma.