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Wednesday, January 01, 2003

By Anita Srikameswaran, Post-Gazette Staff Writer

Gun violence exacts a great emotional toll on society and a big financial toll as well.

Researchers found that the nation's 1997 firearm injuries, the most recent for which complete information was available, cost $802 million in hospital charges.

And almost a third of the patients had no health insurance, which means the hospitals had to absorb the cost of care.

Gunshots were "the leading cause for uninsured hospital days in the country that year," said Dr. Jeff Coben, director of Allegheny General Hospital's Center for Violence and Injury Control. "That was pretty concerning to us and pretty astounding."

He and Dr. Claudia Steiner, of the federal Agency for Healthcare Research and Quality, conducted the analysis being published today in the American Journal of Preventive Medicine.

Estimates of gun violence in the past have been based on data collected by the Centers for Disease Control and Prevention from 100 emergency departments around the country, Coben said. That provided some information about non-fatal shootings, but didn't say much about patients who were admitted to hospitals, such as what procedures they had, how long they stayed and whether their injuries ultimately killed or disabled them.

So for the study, the researchers turned to admission information gathered in 1997 from more than 1,000 hospitals in 22 states, including Pennsylvania, New York and California. The data, which included demographic data, patient conditions, procedures performed and other information, was collected by the AHRQ's Healthcare Cost and Utilization Project.

The researchers concluded there were an estimated 35,810 firearm-related hospital admissions nationwide that year, similar to what the emergency room data predicted.

About 7 percent of people died from their injuries, 12 percent eventually went to another health facility for rehabilitation or other care, and 75 percent recovered and went home.

More than 50 percent of the shootings occurred during assaults, about 30 percent were accidental, 8 percent were self-inflicted and the cause in the remainder was not identifiable. Eighty-six percent of patients were male and about 60 percent were younger than 30.

Overall, 29 percent of patients did not have health insurance. In the assault group, 32 percent were uninsured. Initial stays cost on average almost $24,000 for assault cases and $30,000 for accident cases. Seven out of 10 patients were treated at a large urban teaching hospitals.

The $802 million in hospital costs for gunshot patients "doesn't include physician fees and it doesn't include any follow-up care," Coben pointed out.

A Maryland study estimated that U.S. taxpayers paid almost half of the $2.3 billion cost of lifetime medical care for gunshot wound survivors through medical assistance and disability payments.

So gun violence "isn't just an issue that's isolated to poor people in inner cities," Coben said. "It's going to affect all of us because of the costs involved."

He said that more recent information is now available for analysis and continues to be collected, so it should be possible to look at trends and the impact of new regulations over time. Also, the CDC is starting a violent death reporting system.

In addition to demonstrating the database's ability to monitor the health-care effects of firearms, Coben hopes that the study "will spur some additional discussion and action in the area of trying to reduce gun injuries."