儿童枪支伤害后两年的利用和支出。

Two-Year Utilization and Expenditures for Children After a Firearm Injury.

机构信息

Department of Emergency Medicine and Pediatrics, University of Vermont Medical Center and Children's Hospital, Larner College of Medicine, The University of Vermont, Burlington, Vermont.

Department of Pediatrics, Children's National Hospital, The George Washington University, Washington, District of Columbia.

出版信息

Am J Prev Med. 2022 Dec;63(6):875-882. doi: 10.1016/j.amepre.2022.07.007. Epub 2022 Sep 6.

DOI:10.1016/j.amepre.2022.07.007

PMID:36075816

Abstract

INTRODUCTION

Firearm injuries are a leading cause of morbidity among children, but data on healthcare utilization and expenditures after injury are limited. This study sought to analyze healthcare encounters and expenditures for 2 years after a nonfatal firearm injury.

METHODS

A retrospective cohort study was conducted between 2020 and 2022 of children aged 0-18 years with International Classification of Diseases, Ninth Revision/ICD-10 diagnosis codes for firearm injury from 2010 to 2016 in the Medicaid MarketScan claims database. Outcomes included the difference in healthcare encounters and expenditures, including mental health. Descriptive statistics characterized patient demographics and healthcare utilization. Changes in health expenditures were evaluated with Wilcoxon sign rank tests.

RESULTS

Among 911 children, there were 12,757 total healthcare encounters in the year before the index firearm injury, 15,548 1 encounters in the year after (p<0.001), and 10,228 total encounters in the second year (p<0.001). Concomitantly, there was an overall increase of $14.4 million in health expenditures ($11,415 per patient) 1 year after (p<0.001) and a $0.8 million decrease 2 years after the firearm injury (p=0.001). The children with low previous expenditures (majority of sample) had sustained increases throughout the second year after injury. There was a 31% and 37% absolute decrease in mental health utilization and expenditures, respectively, among children 2 years after the firearm injury.

CONCLUSIONS

Children who experience nonfatal firearm injury have an increased number of healthcare encounters and healthcare expenditures in the year after firearm injury, which is not sustained for a second year. Mental health utilization and expenditures remain decreased up to 2 years after a firearm injury. More longitudinal research on the morbidity associated with nonfatal firearm injuries is needed.

摘要

简介

火器伤是儿童发病和致残的主要原因之一，但有关受伤后医疗保健利用和支出的数据有限。本研究旨在分析非致命性火器伤后 2 年的医疗保健就诊和支出情况。

方法

本回顾性队列研究于 2020 年至 2022 年期间，对医疗保险市场扫描索赔数据库中 2010 年至 2016 年国际疾病分类第 9 版/ICD-10 诊断代码为火器伤的 0-18 岁儿童进行分析。结果包括医疗保健就诊次数和支出的差异，包括心理健康。描述性统计数据描述了患者人口统计学特征和医疗保健利用情况。采用 Wilcoxon 符号秩检验评估健康支出的变化。

结果

在 911 名儿童中，在索引火器伤前一年共有 12757 次总医疗保健就诊，在伤后一年有 15548 次就诊（p<0.001），第二年共有 10228 次就诊（p<0.001）。同时，伤后一年的健康支出总体增加了 1440 万美元（每位患者 11415 美元）（p<0.001），伤后两年健康支出减少了 80 万美元（p=0.001）。之前支出较低（大多数样本）的儿童在受伤后第二年持续增加。伤后两年，儿童心理健康利用和支出分别减少了 31%和 37%。