P0098 - Firearm Injuries: Pediatric long-term health outcomes and healthcare expenditures

Background/Purpose: Firearm injuries are a leading cause of morbidity and mortality among children. Over 40,000 children died by firearms between 2000-2018, and an estimated 200,000 suffered non-fatal firearm injuries during the same period. Despite these staggering figures, there is limited information about the impact of firearm injuries on pediatric health care resource use. Our goal was to evaluate healthcare encounters and expenditures for children one year before and one year following a firearm injury.

Methods: Cohort study of children 0-18 years identified using ICD-9/ICD-10 diagnosis codes for firearm injury in the ED or inpatient setting from 2010-2016 in the Medicaid MarketScan (IBM Watson, Armonk, New York) claims database. Subjects met inclusion criteria if they were continuously enrolled in Medicaid with data availability one year before and one year after a firearm injury during the study period. We identified index injuries by ensuring that each child did not have a firearm injury diagnosis in the year prior. Outcomes included: 1) difference in healthcare encounters for one year before and after injury (outpatient visits, physical, occupational and mental health therapy, emergency department visits, and inpatient admissions); 2) difference in healthcare expenditures pre- and post-firearm injury. Population evaluated in aggregate and among three subgroups based on pre-injury utilization: low prior healthcare utilization (previously healthy patients), high non-mental health utilization, high mental health utilization. Descriptive statistics characterize patient demographics. Health services and expenditures utilized before and after firearm injury evaluated with Wilcoxon Sign Rank Tests.

Results: Of 3,296 children, 83.4% were male (n=2,750), and approximately half were 15-18 years of age (n=1,646) and non-Hispanic African-American/black (n=1,699). Healthy children with low prior healthcare utilization were the largest subgroup (n=2,823). For the entire cohort there were 109,320 healthcare encounters during the entire study period (Table 1); 47,660 before the firearm injury and 61,660 afterward (p<0.001). There was a higher rate of inpatient encounters (post-pre=0.9 visits/patient, p=<0.001) and outpatient encounters (post-pre=0.7 visits/patient, p=<0.001) after the firearm injury. Concomitantly, there was an overall increase of $18.5 million in health expenditures for the entire cohort one-year post-firearm injury, 80% of which were for inpatient healthcare encounters ($14.7 million) (Table 2). Healthy children with low prior healthcare utilization who were injured by a firearm experienced the largest and most significant increases in inpatient healthcare encounters and expenditures after their injury.

Conclusions: Children who experience firearm injury show increases in healthcare encounters and expenditures one-year after the injury. Public health programs that reduce the incidence and impact of childhood firearm injury can also lead to considerable savings in healthcare expenditures. Future research is needed to more fully elucidate the long-term impact of firearm injuries on children, families, healthcare utilization, and expenditures.