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

Authors

Christian D. Pulcini, 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. Electronic address: christian.pulcini@uvm.edu.
Monika K. Goyal, Department of Pediatrics, Children's National Hospital, The George Washington University, Washington, District of Columbia.
Matt Hall, Children's Hospital Association, Lenexa, Kansas.
Heidi Gruhler De Souza, Children's Hospital Association, Lenexa, Kansas.
Sofia Chaudhary, Department of Pediatrics and Emergency Medicine, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
Elizabeth R. Alpern, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Joel A. Fein, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
Eric W. Fleegler, Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts; Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.

Document Type

Journal Article

Publication Date

9-5-2022

Journal

American journal of preventive medicine

DOI

10.1016/j.amepre.2022.07.007

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.

APA Citation

Pulcini, Christian D.; Goyal, Monika K.; Hall, Matt; De Souza, Heidi Gruhler; Chaudhary, Sofia; Alpern, Elizabeth R.; Fein, Joel A.; and Fleegler, Eric W., "Two-Year Utilization and Expenditures for Children After a Firearm Injury" (2022). GW Authored Works. Paper 1665.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1665

Department

Pediatrics