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112 Cost of child and adolescent injury in the United States: by age group, cause, and payer
  1. Rebecca Spicer,
  2. Bruce Lawrence,
  3. Ted Miller
  1. Pacific Institute for Research and Evaluation, Calverton, MD, USA


Background In 2012 in the United States, 13,454 children and adolescents died due to injury and another 9 million visited the emergency department or were hospitalised. However, incidence tells only part of the story. Costs are a better measure of burden by accounting for multiple injury consequences – death, severity, disability – in a single unit of measurement.

Methods We apply an established injury cost model to the Healthcare Cost and Utilisation Program (HCUP) sample-based emergency department and inpatient datasets and the U.S. Multiple Cause of Death file. In addition to medical and work loss costs, we take a societal perspective by including the estimated cost of quality of life and pain and suffering.

Results Injuries (fatal, hospitalised and ED-treated) to 0 through 19 year-olds in 2012 resulted in an estimated $92 billion in medical and work loss costs and an additional $502 billion in quality of life losses. Nonfatal injuries account for the majority (83%) of these costs. Adolescents (ages 15–19) account for 29% of the injuries but 37% of the costs. Falls and struck by/against injuries contribute to 51% of nonfatal injury costs and are the leading causes in all age groups. Assault-related injuries rank 5th, 9th, and 4th among 0–4, 10–14, and 15–19 year-olds, respectively. Self-harm ranks 9th among 15–19 year-olds. Government costs are high with Medicaid paying for 43% of medical costs. Proportion paid by Medicaid is higher among 0–4 year-olds (54%) and among assault (60%), and unintentional firearm (62%), bite and sting (56%), and hot object/substance (55%) injuries. The most severe and debilitating injuries will result in higher costs. Among nonfatal injuries, near-drownings are the most costly. Traffic-related injuries are also among the most severe with pedestrian, motorcycle, and pedalcyclist injuries ranked #2, #4, and #5 in mean injury cost.

Conclusions Cost data support priority-setting and intervention selection. Effectively addressing falls, struck by/against injuries, and assaults will reduce the burden of injury in the United States.

  • cost
  • children
  • cause
  • payer

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