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Abstract
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AJPH recently published an important article by Spitzer et al. that sought to quantify the inflation-adjusted costs associated with firearm-related injuries (FRIs) in the United States.1 The authors’ primary conclusion was that inpatient hospitalizations for these FRIs total more than $700 million per year, and they appropriately emphasized the disproportionate burden of FRIs borne by patients with government insurance (i.e., Medicaid) and the self-paying poor. I agree completely with both the authors’ nine-year (2006–2014) analyses of Nationwide Inpatient Sample (NIS) data and these important inferences. In fact, my colleagues and I made nearly identical arguments in a similar article approximately two years earlier.2
Spitzer et al. stated in their introduction that, “[t]o our knowledge, the most recent estimation of the medical costs of firearm injuries extends through 1997 and uses hospital data from only two states” (p.770). However, the authors and the peer-review process overlooked a comprehensive 14-year (1998–2011) analysis of serious, nonlethal FRIs in the United States that I conducted along with my colleagues using the same publicly available NIS databases and exactly the same series of ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes to define FRIs. That analysis was published in a special issue of Family Medicine and Community Health (FMCH) coordinated with the Baylor College of Medicine Department of Family and Community Medicine.
Despite being open access and indexed in EBSCO, OCLC, Primo Central, Scopus, and other databases (e.g., Google Scholar), FMCH is a newer journal with a pending PubMed application, which may explain any unintentional failure to acknowledge or cite our study. The primary aim of this letter is to supplement the recently published Spitzer et al. article with findings from our study, omitted until now.
As mentioned, with the exception of slightly different time frames, the NIS databases and case definitions used in the two studies are identical. In addition to the cost and financial burden analyses conducted by Spitzer et al., we (1) described temporal trends in inpatient hospitalizations for FRIs via joinpoint regression, (2) used multivariable modeling to investigate individual- and hospital-level sociodemographic and clinical characteristics associated with FRIs and FRI subtypes (e.g., manner or intent of injury and location of injury), and (3) estimated not only the costs of inpatient care, but also lengths of stay and rates of in-hospital mortality among subgroups of patients hospitalized for FRIs. Briefly, the highest odds of an FRI were observed among patients aged 24 years or younger, self-paying or uninsured patients, and non-Hispanic Blacks. The mean inpatient length of stay for an FRI was 6.9 days; however, 4.7% of patients remained in the hospital more than 24 days, and one in 12 (8.2%) died prior to discharge. Additional results are available in the article ...
1. Spitzer SA, Staudenmayer KL, Tennakoon L, Spain DA, Weiser TG. Costs and financial burden of initial hospitalizations for firearm injuries in the United States, 2006–2014. Am J Public Health. 2017;107(5):770–774.
2. Salemi JL, Jindal V, Wilson RE, Mogos MF, Aliyu MH, Salihu HM. Hospitalizations and healthcare costs associated with serious, non-lethal firearm-related violence and injuries in the United States, 1998–2011. Fam Med Community Health. 2015;3(2):8–19.
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