TOPLINE:

Firearm injuries in the US led to total healthcare costs of $7.7 billion from 2016 to 2021, with inpatient admissions accounting for 93% of the costs and emergency department (ED) visits contributing the remainder, a study found. Spending increased after 2019 amid the COVID‑19 pandemic as injury rates increased, whereas per‑visit costs remained stable.

METHODOLOGY:

• Researchers conducted an economic evaluation using observational administrative data from Statewide Inpatient Databases and State Emergency Department Databases from 2016 to 2021 to estimate national hospital costs for initial firearm injuries.
• They performed a Monte Carlo simulation with 2400 iterations using data from Arkansas, Florida, Maryland, Massachusetts, New York, and Wisconsin, incorporating patients of all ages and injuries of any intent.
• The analysis included 484,567 hospital visits for new firearm injuries, comprising 298,721 ED visits and 185,846 inpatient hospital admissions identified using International Classification of Diseases, Tenth Revision codes.
• The primary outcome was the total healthcare visit cost, adjusted to 2024 US dollars.
• Other outcomes were the mean cost per visit, annual trends in total and mean costs, and cost distributions by patient demographics, injury characteristics, and hospital features.

TAKEAWAY:

• The total healthcare costs were $7.7 billion from 2016 to 2021, with 93% attributed to inpatient admissions (mean, $38,879 per visit) and a mean ED cost of $1743.
• Annual aggregate costs remained stable at $1.2 billion until 2020 and increased to $1.6 billion in 2021, whereas mean costs per visit remained constant throughout the study period.
• Assault-related injuries led to the highest mean inpatient costs at $43,392, followed by self-inflicted injuries at $40,159; injuries involving multiple body regions averaged $53,856.
• Healthcare costs were highest among men, Black individuals, Medicaid payers, and residents of lowest‑income ZIP codes. Children (< 18 years) accounted for $684 million in costs, with sharp increases after 2019. Most costs were incurred by large hospitals, level I trauma centers, and medical school-affiliated hospitals.

IN PRACTICE:

"In this economic evaluation study, new firearm injuries created an estimated $7.7 billion in ED-only and inpatient hospital health care costs from 2016 to 2021," the authors wrote. "These data can inform decision-makers who prioritize firearm injury prevention strategies at the patient level. The data can also inform policies to support the hospitals disproportionally affected by firearm injury costs," they added.

SOURCE:

The study was led by Regina Royan, MD, MPH, University of Michigan, Ann Arbor, Michigan. It was published online on September 26, 2025, in JAMA Health Forum.

LIMITATIONS:

The data used in the study may not have fully represented the demographic composition in the US, and calendar‑year linkage may have led to undercounting of reinjury. The analysis captured only acute care hospital costs, excluding other healthcare system expenses such as pre-hospital care costs, professional fees, and post-acute care costs. The study did not account for costs incurred by survivors, their caregivers, or their communities.

DISCLOSURES:

Study funding information was not provided. One author reported receiving funds from the National Institute of Neurological Disorders and Stroke and serving as an Assistant Editor for JAMA Network Open outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.