Every year, 40,000 people in the United States are killed with firearms. But another 85,000 are shot and survive. A new study quantifying the impacts of gun violence on these survivors and their families finds that they face increased risk of mental health disorders and substantially higher healthcare spending. Spending on gunshot survivors alone in the first year after their injury is estimated at about $2.5 billion—most of that cost burden carried by employers, insurers, and publicly-funded health programs.
In addition to obvious physical injury, the study found that “there are substantial mental health repercussions for both the survivors and their family members through a year following a shooting,” says lead author and associate professor of health care policy Zirui Song, who is a physician at Massachusetts General Hospital. And there is an increased risk for substance abuse among survivors, who are often coping with pain. “Understanding how firearm injuries reverberate across peoples’ lives and families provides insights that we can use to provide better care for patients”—for example, by screening survivors and their family members for signs of mental health problems or substance use disorders. “The heightened risk for these complications among both survivors and their families,” says Song, “should be on clinicians’ radars….”
Using data culled from a decade of Medicare and commercial insurance claims, the study compared outcomes for about 6,500 gunshot survivors (and more than 12,000 family members of gunshot survivors) to more than 32,000 matched controls (and more than 62,000 matched family member controls). He and his team found that in the year after a nonfatal firearm injury, direct spending on survivors increased $2,495 a month compared with demographically and clinically matched controls. Survivors also experienced a 40 percent increase in pain diagnoses, a 51 percent increase in psychiatric disorders, and an 85 percent increase in substance use disorders compared to uninjured peers. At the same time, their family members suffered a 12 percent increase in psychiatric disorders compared to matched controls.
“We found changes in medical spending attributable to firearm injury,” write the study authors, “that were a 4-fold increase from baseline spending—totaling about $30,000 per survivor in the first year. This increase was mostly paid (96 percent) by insurers, self-insured employers, or Medicare, with the remainder (4 percent) paid out of pocket by patients.”
Commenting on this analysis, professor of health policy David Hemenway (who was not involved in the study), said that the research is part of “a broad and growing literature documenting the enormous costs that gun violence imposes on our society—costs that are far larger than deaths and immediate injuries.” For example, he said, “many studies have shown that exposure to violence—as a victim, bystander, or even just a part of the community—is associated with subsequent higher rates of lifetime mental and physical health problems, and that exposure to gun violence can be particularly detrimental to long-term health.” A recent review found 31 articles focusing on the effects of youth exposure to firearm violence and concluded that “the behavioral and physical health consequences of youth exposure to firearm injury are consistently reported as high.” Studies also find that being the victim of gun crime rather than a similar crime using other weapons, leads to a higher likelihood of subsequent emotional and physical symptoms and more problems at school, work, and with family and peers.
This latest study highlights the impact of nonfatal firearm injuries on medical expenses for survivors and families—but by no means captures all the quantifiable effects of gun violence. “Some of the largest costs… have been the most difficult to measure accurately,” Hemenway notes, “such as when people and institutions try to protect themselves from future shootings (e.g., loss of jobs and community social capital; school lockdown drills; juveniles obtaining guns and joining gangs for protection).”
He adds that Song and colleagues’ research “provides more evidence that the scope of our firearm problem is far greater than suggested by merely counting dead and injured bodies.” The impacts include “financial, social, psychological, and physical health costs, imposed on victims, shooters, families, friends, and communities throughout the nation. What has been missing is a societal response commensurate with the size of our firearm-related problems.”
For Hemenway’s suggested public-health approach to gun homicides and suicides, read the Harvard Magazine Forum article “Doing Less Harm” or listen to Harvard Magazine’s “Ask a Harvard Professor” podcast interview with him.
