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Citation
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Brough SC, Tennakoon L, Spitzer SA, Thomas A, Forrester JD, Spain DA, Weiser TG. Am. J. Prev. Med. 2023; ePub(ePub): ePub. |
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Abstract
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INTRODUCTION: Firearm injury-related hospitalizations in the United States cost $900 million annually. Prior to the Affordable Care Act (ACA), government insurance programs covered 41% of costs. This study describes the effect of ACA Medicaid expansion and state level firearm legislation on coverage and costs for firearm injuries.
METHODS: This cross-sectional study included 35,854,586 hospitalizations from 27 states in 2013 and 2016. Data analyses were performed in 2022. Firearm injuries were classified by mechanism: assault, unintentional, self-harm, or undetermined. Impact of ACA expansion was determined using difference-in-differences analysis. Differences in per capita costs between states with stronger and weak firearm legislation were compared using univariable and multivariable analyses.
RESULTS: The authors identified 31,451 initial firearm injury-related hospitalizations. In states with weak firearm legislation, hospitalization costs per 100,000 residents were higher from unintentional ($25,834; p=0.04) and self-inflicted injuries ($11,550; p=0.02); there were no state-level differences in assault or total per capita firearm-related hospitalization costs. ACA expansion increased government coverage of costs by 15 percentage points (95% CI 3-29) and decreased costs to uninsured/self-pay by 14 percentage points (95% CI 6-21). In 2016, states with weak firearm legislation and no ACA expansion had the highest proportion of hospitalization costs attributed to uninsured/self-pay patients (24%, 95% CI 15-34).
CONCLUSIONS: ACA expansion increased government coverage of hospitalizations for firearm injuries. Unintentional and self-harm costs were significantly higher for states with weak firearm legislation. States with weak firearm legislation that did not expand Medicaid had highest proportion of uninsured/self-pay patients. LEVEL OF EVIDENCE: Economic & Value Based Evaluations, Level III.
Language: en |