Nonfatal firearm injuries associated with increased psychiatric disorders and substance use disorders

1. Survivors of nonfatal firearm injuries experienced an increase in psychiatric disorders, substance use disorders, pain diagnoses, and worsening mental health among family members.

2. In survivors of nonfatal firearm injuries, they experienced increases in healthcare spending and use.

Evidence Rating Level: 2 (Good)

Study Rundown: There are roughly 85,000 survivors of nonfatal firearm injuries annually in the US from 2009 to 2017. However, literature on the clinical effects of nonfatal firearm injuries is sparse, and prior studies have not focused on patient out-of-pocket spending, clinical services delivered, prescription drug use, or changes in the clinical burden of disease. Therefore, there is a gap in knowledge as to understanding how nonfatal firearm injuries affect the mental and behavioral health conditions of survivors, their healthcare utilization patterns, as well as how these injuries might affect family members of survivors. This study found that among survivors of nonfatal firearm injuries, they experienced increases in psychiatric disorders, substance use disorders, and pain diagnoses, along with increased healthcare spending and utilization. This study also found that mental health worsened among family members of survivors. This study was limited by the imprecision of diagnostic codes and limited generalizability to other patient populations, including Medicaid and uninsured patients. Nevertheless, these study’s findings are significant, as they demonstrate that nonfatal firearm injuries led to significantly worse clinical and economic outcomes among survivors and their family members.

Click to read the study in AIM

Relevant Reading: Increases in Actual Health Care Costs and Claims After Firearm Injury

In-Depth [cohort study]: This national cohort study examined patients using the MarketScan Medicare and commercial claims data from 2008 to 2018, to measure changes in clinical and economic outcomes after nonfatal firearm injuries among survivors and their associated family members. Patients who were survivors of firearm injuries, who were continuously enrolled in insurance for at least 1 year before and 1 year after an incident of firearm injury were eligible for the study. Patients who did not have a nonfatal firearm injury or were not in the MarketScan database were excluded from the study. The primary outcomes measured were changes in health care spending, use, prescription drug use, and morbidity from preinjury through 1-year postinjury relative to control participants. Outcomes of the primary analysis were assessed via matched control groups using risk-set matching based on insurer, prescription drug coverage, sex, and metropolitan statistical area of the person. Based on the analysis, after a nonfatal firearm injury, medical spending increased $2495 per person per month and cost-sharing increased by $102 per person per month among survivors relative to control participants after the first year after injury (P<0.001). This was primarily driven by a significant increase in spending in the first month ($25,554). Survivors also had a 40% increase in pain diagnoses, a 51% increase in psychiatric disorders, and an 85% increase in substance use disorders after firearm injury relative to control participants (P<0.001). Family members of survivors also had a 12% increase in psychiatric disorders relative to their control participants (P = 0.003). Overall, this study demonstrates that nonfatal firearm injuries lead to increases in psychiatric disorders, substance use disorders, pain diagnoses, and increased healthcare spending and use, along with worsening mental health among their family members.

Image: PD

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