美国儿科 firearm 损伤医疗费用的趋势。
United States trends in healthcare charges for pediatric firearm injuries.
机构信息
Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
Division of Emergency Medicine and Trauma Services, Children's National Health System, Washington, DC, United States of America.
出版信息
Am J Emerg Med. 2021 Sep;47:58-65. doi: 10.1016/j.ajem.2021.03.046. Epub 2021 Mar 20.
BACKGROUND
From 2009 to 2016, >21,000 children died and an estimated 118,000 suffered non-fatal injuries from firearms in the United States. Limited data is available on resource utilization by injury intent. We use hospital charges as a proxy for resource use and sought to: 1) estimate mean charges for initial ED and inpatient care for acute firearm injuries among children in the U.S.; 2) compare differences in charges by firearm injury intent among children; and 3) evaluate trends in charges for pediatric firearm injuries over time, including within intent subgroups.
METHODS
In this repeated cross-sectional analysis of the 2009-2016 Nationwide Emergency Department Sample, we identified firearm injury cases among children aged ≤19 years using ICD-9-CM and ICD-10-CM external cause of injury codes (e-codes). Injury intent was categorized using e-codes as unintentional, assault-related, self-inflicted, or undetermined. Linear regressions utilizing survey weighting were used to examine associations between injury intent and healthcare charges, and to evaluate trends in mean charges over time.
RESULTS
Among 21,951 unweighted cases representing 102,072 pediatric firearm-related injuries, mean age was 16.6 years, and a majority were male (88.2%) and publicly insured (51.5%). Injuries were 53.9% assault-related, 37.7% unintentional, 1.8% self-inflicted, and 6.7% undetermined. Self-inflicted injuries had higher mean charges ($98,988) than assault-related ($52,496) and unintentional ($28,618) injuries (p < 0.001). Self-inflicted injuries remained associated with higher mean charges relative to unintentional injuries, after adjusting for patient demographics, hospital characteristics, and injury severity (p = 0.015). Mean charges for assault-related injuries also remained significantly higher than charges for unintentional injuries in multivariable models (p < 0.001). After adjusting for inflation, mean charges for pediatric firearm-related injuries increased over time (p-trend = 0.018) and were 23.1% higher in 2016 versus 2009. Mean charges increased over time among unintentional injuries (p-trend = 0.002), but not among cases with assault-related or self-inflicted injuries.
CONCLUSIONS
Self-inflicted and assault-related firearm injuries are associated with higher mean healthcare charges than unintentional firearm injuries among children. Mean charges for pediatric firearm injuries have also increased over time. These findings can help guide prevention interventions aimed at reducing the substantial burden of firearm injuries among children.
背景
从 2009 年到 2016 年，美国有超过 21000 名儿童死亡，118000 多名儿童遭受非致命枪支伤害。关于伤害意图的资源利用情况的数据有限。我们使用医院收费作为资源利用的代理指标，并试图：1）估计美国儿童急性火器伤急诊和住院初始治疗的平均费用；2）比较不同伤害意图的儿童之间的收费差异；3）评估儿科火器伤收费随时间的变化趋势，包括意图亚组内的变化趋势。
方法
在这项对 2009-2016 年全国急诊部样本的重复横断面分析中，我们使用 ICD-9-CM 和 ICD-10-CM 外部原因伤害代码（e 代码）确定了 19 岁以下儿童的火器伤害病例。伤害意图使用 e 代码分为非故意、与攻击相关、自我伤害或未确定。利用调查加权的线性回归来检查伤害意图与医疗费用之间的关联，并评估随时间推移的平均费用趋势。
结果
在 21951 个未加权病例中，代表了 102072 例儿科火器相关伤害，平均年龄为 16.6 岁，大多数为男性（88.2%）和公共保险（51.5%）。伤害的 53.9%是与攻击相关的，37.7%是非故意的，1.8%是自我伤害的，6.7%是未确定的。自我伤害的平均费用（98988 美元）高于与攻击相关的费用（52496 美元）和非故意的费用（28618 美元）（p<0.001）。在调整了患者人口统计学、医院特征和伤害严重程度后，自我伤害与非故意伤害相比，仍与较高的平均费用相关（p=0.015）。在多变量模型中，与非故意伤害相比，与攻击相关的伤害的平均费用也显著更高（p<0.001）。在调整了通胀因素后，儿科火器相关伤害的平均费用随时间增加（p 趋势=0.018），2016 年比 2009 年增加了 23.1%。非故意伤害的平均费用随时间增加（p 趋势=0.002），但与攻击相关或自我伤害的病例无关。
结论
自我伤害和与攻击相关的火器伤害与儿童非故意火器伤害相比，平均医疗费用更高。儿科火器伤的平均费用也随时间增加。这些发现可以帮助指导旨在减少儿童火器伤害严重负担的预防干预措施。
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