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

• Published in: American journal of preventive medicine Vol. 63; no. 6; pp. 875 - 882
• Main Authors: Pulcini, Christian D., Goyal, Monika K., Hall, Matt, De Souza, Heidi Gruhler, Chaudhary, Sofia, Alpern, Elizabeth R., Fein, Joel A., Fleegler, Eric W.
• Format: Journal Article
• Language: English
• Published: New York Elsevier Science Ltd 01-12-2022
• Subjects: Children; Cohort analysis; Expenditures; Firearms; Health care expenditures; Health services utilization; Injuries; Medicaid; Medical diagnosis; Mental health; Morbidity; Pediatrics
• ISSN: 0749-3797; 1873-2607
• DOI: 10.1016/j.amepre.2022.07.007

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.