Medical Expenditures Attributable to Injuries --- United States, 2000

MEPS is a nationally representative survey of the U.S. civilian, noninstitutionalized population that quantifies insurance costs and out-of-pocket spending for all medical services, including inpatient hospitalizations, emergency department visits, ambulatory care, prescription drugs, home health care, mental health care, dental visits, and medical devices. Each MEPS panel is a sample population from the previous year's National Health Interview Survey respondents. MEPS also includes data on the sociodemographic characteristics of respondents and self-reported medical conditions, defined on the basis of International Classification of Diseases, Ninth Revision, Clinical Modifications (ICD-9-CM) codes (4). A total of 25,096 respondents completed the survey. For each condition coded, respondents were asked, "Was the condition due to an accident/injury?" and whether it involved "a motor vehicle, gun, some other weapon, poisoning/poisonous substance, fire/burn, drowning/near drowning, sports injury, fall, or something else." Only self-reported injuries that were coded with ICD-9-CM classifications 800--957 and 959--994 were included in the analysis. These codes represent damage to the human body caused by acute exposure to energy (i.e., mechanical, thermal, electrical, chemical, or radiant) or by sudden lack of essential agents (e.g., heat or oxygen) and are consistent with the injury definition used by the International Collaborative Effort on Injury Statistics (5).

A four-part regression model commonly applied to medical-expenditure data was used to estimate the percentage of total injury-attributable medical expenditures. This model accounted for the skewed distribution of expenditures among persons and differences in the distribution of expenditures among those with and without inpatient admissions during the year. Each part included a dichotomous independent variable to indicate whether a participant reported injury treatment in 2000, thereby allowing for estimating the marginal impact of injuries on total annual medical expenditures. All regression models controlled for sex, race/ethnicity, region, household income, education, pregnancy status, and marital status. A more complete estimate of injury-attributable expenditures was obtained by applying age- and sex-specific MEPS estimates of the percentage of injury-attributable medical expenditures in 2000 to medical-spending data provided by NHA, which includes the U.S.-based military and institutionalized populations. NHA measures spending for health care in the United States by type of service delivered and source of funding for those services.

In 2000, a total of 16.3% of persons (44.7 million) in the United States reported requiring treatment for at least one injury (Table). The percentage was higher for males (17.3%) than for females (15.4%). By age group, the percentage of persons reporting treatment for an injury ranged from 11.9% for persons aged <10 years to 17.9% for persons aged 10--19 years. Among persons aged <45 years, a greater percentage of males reported treatment for an injury; among persons aged >45 years, a greater percentage of females reported treatment for an injury.

In 2000, injury-attributable medical expenditures accounted for 10.3% of total medical expenditures and were higher for males (12.5%) than females (9.2%). By age group, the percentage of total injury-attributable medical expenditures ranged from 6.8% for persons aged 20--29 years to 16.6% for persons aged 10--19 years. Males had a higher percentage of injury-attributable medical expenditures than females for all age groups, except persons aged 45--64 years.

In 2000, on the basis of MEPS estimates, $64.7 billion was spent treating injuries among the U.S. population. When MEPS percentages were applied to annual medical-spending data provided by NHA, injury-attributable medical expenditures nearly doubled to $117.2 billion. Injury-attributable medical expenditures were higher for males ($59.8 billion) than females ($57.4 billion). By age group, NHA expenditures ranged from $5.0 billion for persons aged 20--29 years to $37.9 billion for persons aged 45--64 years. The greatest injury-attributable medical expenditures ($23.3 billion) were for women aged 45--64 years. Expenditures per capita for women were greater than for men in the same age group (Table).

Approximately 30% of injured persons sampled reported injuries involving falls (21.2%) and motor vehicles (9.0%). These self-reported injuries accounted for approximately 51% of total injury-attributable medical expenditures, with falls accounting for 33% and motor vehicles for 18%. The remaining 70% of injured persons sampled reported one of the other categories as the cause of injury, with the majority reporting "something else."

Reported by: EA Finkelstein, PhD, IC Fiebelkorn, Research Triangle Institute International, Research Triangle Park, North Carolina. PS Corso, PhD, SC Binder, MD, National Center for Injury Prevention and Control, CDC.

Editorial Note:

The findings in this report indicate that the percentage of total medical expenditures attributable to injuries (10.3%) is similar to previous estimates of medical costs of injuries (10.4%) and to percentages of expenditures for other leading public health concerns, such as overweight and obesity (9.1%) and smoking (6.5%--14.4%) (6--8). However, the true economic burden of injuries is likely greater than the estimates described in this report because these estimates do not include the value of life lost to premature mortality, loss of patient and caregiver time, nonmedical expenditures (e.g., wheelchair ramps), insurance costs, property damage, litigation, decreased quality of life, and diminished functional capacity. Long-term--noninjury health consequences (e.g., mental health--care costs) are another important component not quantified in these estimates.

The majority of injuries can be prevented. For example, multifaceted intervention programs, including balance training, vision correction, reducing medications to the fewest number and lowest doses, and environmental changes, can reduce the risk for falls and fall injuries substantially among older adults (9). Interventions to prevent motor-vehicle crashes are similarly available (10).

The findings in this report are subject to at least two limitations. First, the lack of specificity in MEPS about the underlying cause and intent of injury provides little information to guide injury-prevention programs; injury data are not distinguished by intentionality (e.g., self-inflicted). Second, because it relies on self-reported data, MEPS does not include medical expenditures for the majority of fatal injuries. NHA includes costs for all medical expenditures in the United States. However, NHA injury-attributable expenditure estimates assume that the percentage of total expenditures attributable to injuries is the same for both the institutionalized and noninstitutionalized populations and for the civilian and noncivilian populations. However, severely injured patients might constitute a substantial proportion of the institutionalized population (e.g., residents of nursing homes), and persons in the military might be more prone to injuries than civilians.

Injuries impose a substantial economic burden on society. Effective interventions (e.g., increased use of child-restraint systems, smoke alarm installation programs, and programs to prevent falls among older adults) to decrease both unintentional and intentional injuries might substantially reduce this economic burden.

References

1. CDC. Web-based Injury Statistics Query and Reporting System (WISQARS). U.S. Department of Health and Human Services, CDC, National Center for Injury Prevention and Control, 2002. Available at http://www.cdc.gov/ncipc/wisqars.
2. Agency for Healthcare Research and Quality. Medical expenditure panel survey, 2000. Rockville, Maryland: Agency for Healthcare Research and Quality, 2000. Available at http://www.meps.ahrq.gov.
3. Levit K, Smith C, Cowan C, Lazenby H, Martin A. Inflation spurs health spending in 2000. Health Aff 2002;21:172--81.
4. World Health Organization. International Classification of Diseases, Ninth Revision, Clinical Modification. Geneva, Switzerland: World Health Organization, 1978.
5. CDC. Proceedings of the International Collaborative Effort on Injury Statistics, Volume IV, April 2003. U.S. Department of Health and Human Services, CDC, National Center for Health Statistics, 2003. Available at http://www.cdc.gov/nchs/data/ice/iceproceedings.pdf.
6. Hodgson T, Cohen A. Medical expenditures for major diseases, 1995. Health Care Financing Review 1999;21:119--64.
7. Finkelstein E, Fiebelkorn I, Wang G. National medical spending attributable to overweight and obesity: how much, and who's paying? Health Aff 2003;(suppl):W3-219--26.
8. Warner K, Hodgson T, Carroll C. Medical costs of smoking in the United States: estimates, their validity, and their implications. Tob Control 1999;8:290--300.
9. Rand Southern California Evidence-Based Practice Center. Evidence report and evidence-based recommendations: falls prevention interventions in the Medicare population, 2002. Available at http://www.cms.hhs.gov/healthyaging/fallspi.asp.
10. Task Force on Community Preventive Services. Recommendations to reduce injuries to motor vehicle occupants: increasing child safety seat use, increasing safety belt use, and reducing alcohol-impaired driving. Am J Prev Med 2001;21(suppl 4):16--22.

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