Alghnam Suliman, Vanness David J, Gaskin Darrell J, Thorpe Roland J, Castillo Renan
From the Department of Health Policy and Management (S.A., R.C.), Johns Hopkins Bloomberg School of Public Health; and Health Policy and Management (D.G.), and Health, Behavior and Society (R.T.), Johns Hopkins University, Baltimore, Maryland; and Population Health (D.V.), University of Wisconsin, Madison, Wisconsin.
J Trauma Acute Care Surg. 2016 Feb;80(2):258-64. doi: 10.1097/TA.0000000000000910.
Every year, as many as 31 million Americans sustain traumatic injuries, leaving survivors with risks of disabilities and health settings with staggering medical costs. Little is known on the societal burden of injuries in terms of medical and out-of-pocket expenditures. Therefore, we used a nationally representative sample to evaluate the association between injuries and health expenditures among a nationally representative US sample.
This study used years 2006 to 2010 (Panels 11-14; n = 53,065) of the Medical Expenditure Panel Survey. Each panel was followed up for 2 years. Total expenditures included insurance payments and out-of-pocket costs. Two-part models were constructed to examine differences in annual medical expenditures between injured and noninjured populations controlling for confounding effects.
A total of 4,210 individuals (7.9%) reported injuries representing 21.5 million individuals. Injured individuals were more likely to be males, to be white, and to report higher medical expenditures in the second year than the reference population (p < 0.01). Adjusted analyses showed that reporting any injury was associated with $2,577 (95% confidence interval [CI], $2,049-$3,103) and $186 (95% CI, $142-$230) increase in total and out-of-pocket costs, respectively. While a moderate or severe injury was associated with $4,779 (95% CI, $3,947-$5,610) increase in the average of medical expenditures and $256 (95% CI, $190-$322) increase in out-of-pocket costs adjusting for covariates. Our adjusted national medical cost of injuries was estimated at $56 billion and out-of-pocket cost to be approximately $4 billion.
Injuries pose a substantial burden on medical expenditures in the United States. Investment in injury prevention can facilitate reducing medical expenditures and save resources. Prevention programs may use the out-of-pocket findings to highlight injury burden on individual's prosperity and thus facilitate engagement of the public in prevention.
Economic and evaluation study, level III.
每年多达3100万美国人遭受创伤性损伤，幸存者面临残疾风险，医疗机构也承担着惊人的医疗费用。关于损伤在医疗和自付费用方面的社会负担，人们了解甚少。因此，我们使用了一个具有全国代表性的样本，来评估美国一个具有全国代表性样本中损伤与医疗支出之间的关联。
本研究使用了医疗支出面板调查2006年至2010年的数据（第11 - 14组；n = 53,065）。每个组随访2年。总支出包括保险支付和自付费用。构建了两部分模型，以检验在控制混杂效应的情况下，受伤人群和未受伤人群年度医疗支出的差异。
共有4210人（7.9%）报告了损伤，代表2150万人。与参照人群相比，受伤个体更可能为男性、白人，且在第二年报告的医疗支出更高（p < 0.01）。调整分析显示，报告任何损伤分别与总费用增加2577美元（95%置信区间[CI]，2049 - 3103美元）和自付费用增加186美元（95% CI，142 - 230美元）相关。而中度或重度损伤在调整协变量后，与医疗支出平均增加4779美元（95% CI，3947 - 5610美元）和自付费用增加256美元（95% CI，190 - 322美元）相关。我们估计全国损伤的调整后医疗费用为560亿美元，自付费用约为40亿美元。
损伤给美国的医疗支出带来了巨大负担。投资于损伤预防有助于减少医疗支出并节省资源。预防项目可利用自付费用的研究结果，突出损伤对个人财富的负担，从而促进公众参与预防。
经济与评估研究，III级。
