Department of Health Care Policy, Harvard Medical School and Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts (Z.S.).
Department of Health Care Policy, Harvard Medical School, Department of Biostatistics and CAUSALab, Harvard T.H. Chan School of Public Health, and Department of Statistics, Faculty of Arts and Sciences, Harvard University, Boston, Massachusetts (J.R.Z.).
Ann Intern Med. 2022 Jun;175(6):795-803. doi: 10.7326/M21-2812. Epub 2022 Apr 5.
Despite increasing awareness of firearm-related deaths, evidence on the clinical and economic implications of nonfatal firearm injuries is limited.
To measure changes in clinical and economic outcomes after nonfatal firearm injuries among survivors and their family members.
Cohort study.
MarketScan Medicare and commercial claims data, 2008 to 2018.
6498 survivors of firearm injuries matched to 32 490 control participants and 12 489 family members of survivors matched to 62 445 control participants.
Exposure to nonfatal firearm injury as a survivor or family member of a survivor.
Changes in health care spending, use, and morbidity from preinjury through 1 year postinjury relative to control participants, on average and by type and severity of firearm injury.
After nonfatal firearm injury, medical spending increased $2495 per person per month (402%) and cost sharing increased $102 per person per month (176%) among survivors relative to control participants ( < 0.001) in the first year after injury, driven by an increase in the first month of $25 554 (4122%) in spending and $1112 (1917%) in cost sharing per survivor ( < 0.001). All categories of health care use increased relative to the control group. Survivors had a 40% increase in pain diagnoses, a 51% increase in psychiatric disorders, and an 85% increase in substance use disorders after firearm injury relative to control participants ( < 0.001), accompanied by increased pain and psychiatric medications. Family members had a 12% increase in psychiatric disorders relative to their control participants ( = 0.003). These overall clinical and economic changes were driven by intentional firearm injuries and more severe firearm injuries.
Precision of diagnostic codes and generalizability to other patient populations, including Medicaid and uninsured patients.
In survivors, nonfatal firearm injuries led to increases in psychiatric disorders, substance use disorders, and pain diagnoses, alongside substantial increases in health care spending and use. In addition, mental health worsened among family members.
National Institutes of Health.
尽管人们对与枪支有关的死亡事件的认识不断提高，但有关非致命性枪支伤害的临床和经济影响的证据仍然有限。
衡量非致命性枪支伤害幸存者及其家属的临床和经济结果的变化。
队列研究。
2008 年至 2018 年，市场扫描医疗保险和商业索赔数据。
6498 名枪支伤害幸存者与 32490 名对照参与者相匹配，12489 名幸存者的家庭成员与 62445 名对照参与者相匹配。
作为幸存者或幸存者的家庭成员，接触非致命性枪支伤害。
与对照参与者相比，受伤前至受伤后 1 年期间，幸存者及其家庭成员的医疗支出、使用和发病率的变化，平均而言，以及按枪支伤害的类型和严重程度划分。
非致命性枪支伤害后，与对照参与者相比，幸存者每月的医疗支出增加 2495 美元（402%），每月自付费用增加 102 美元（176%）（<0.001），这是由于受伤后第一个月的支出增加了 25554 美元（4122%）和每个幸存者的自付费用增加了 1112 美元（1917%）（<0.001）。与对照组相比，所有类别的医疗保健使用均有所增加。与对照参与者相比，枪支伤害后幸存者的疼痛诊断增加了 40%，精神障碍增加了 51%，物质使用障碍增加了 85%（<0.001），同时疼痛和精神科药物的使用也增加了。与对照参与者相比，家庭成员的精神障碍增加了 12%（=0.003）。这些总体的临床和经济变化是由蓄意的枪支伤害和更严重的枪支伤害引起的。
诊断代码的精度和在其他患者群体（包括医疗补助和无保险患者）中的推广性。
在幸存者中，非致命性枪支伤害导致精神障碍、物质使用障碍和疼痛诊断增加，同时医疗支出和使用大幅增加。此外，家庭成员的心理健康状况恶化。
美国国立卫生研究院。
