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  • Critical Care Illness

    While the human suffering and death caused by injury is well recognized, injury has a significant economic impact that must be considered when public policy regarding trauma centers is debated or discussed.

    The human costs alone are staggering. Unintentional injury is the fifth leading cause of death after heart disease, cancer, chronic lower respiratory disease, and stroke. When one also includes intentional injury in the form of suicide and homicide, injury becomes the third leading cause of death. In 2007, a total of 176,665 Americans died as the result of injury.  According to the world health organization, worldwide, road collisions alone killed 2.1 million people in 2008 while intentional injury resulted in another 2.7 million deaths. Unlike the other leading causes of death, however, injury disproportionately strikes younger individuals. In the United States, injury is the leading cause of death for individuals between 1 and 44 years of age. In fact, for those between 1 and 34 years of age, injury kills more people than all other major causes combined. While injury is the fifth leading cause of death overall, it is the leading reason for lost productive years of life. In the United States in 2007, injury resulted in approximately 3.7 million years of lost productive life based on a retirement age of 65 years. Malignant neoplasms, the next most common reason for lost productive life, caused 1.9 million years of lost productive life during that same year, barely more than half that attributable to injury.

    While the human costs are certainly enormous, the economic costs are equally staggering. When an individual is killed or permanently disabled the costs to society include not only the medical expenses involved in their care, but also the cost of the goods not produced and the services not provided by that individual for the duration of what would have been their working life.  Since injury is the leading cause of lost productive years of life, it is also the leading cause of lost wages and productivity.  In 2005, fatal unintentional injury resulted in $1,374,873,000 in medical costs. While this is an enormous sum, it is dwarfed by the $82,942,825,000 in lost work costs. Thus fatal unintentional injuries alone cost the economy $84,317,698,000 in 2005. Deaths due to violence resulted in $215,106,000 in medical costs and $46,972,387,000 in lost work costs for a total cost of $47,187,493,000. Deaths of undetermined intent cost the United States another $29,323,000 in medical costs and $4,176,427,000 in lost work costs for a total of $4,205,750,000. Thus, injury related deaths as a whole cost the United States nearly 136 billion dollars in 2005 alone.

    Most injuries, however, are not fatal. Non fatal injuries add to the overall costs of injury. Medical costs for those individuals sustaining nonfatal unintentional injuries resulting in hospitalization in 2005 totaled $36,081,699,000 with $62,859,463,000 in lost work costs for a total cost of $98,941,162,000. Individuals hospitalized as a result of intentional injury generated $4,397,676,000 in medical costs and another $11,039,265,000 in lost work costs for total costs of $15,436,941,000. Medical costs for those with unintentional injuries treated in emergency departments and released resulted in $32,691,860,000 in medical costs and $65,383,720,000 in lost work costs for total costs to the United States economy of $98,075,580,000. Those with intentional injuries treated in emergency departments and released resulted in an additional $2,393,863,000 in medical costs and $4,787,725,000 in lost work costs totaling $7,181,588,000. When all of these costs are added together, injuries requiring medical treatment or resulting in death cost the United States economy $355,346,212,000 in 2005. That translates to approximately 48 cents for every dollar spent on food in the United States in 2007. Seventy eight percent of this cost was due to lost wages and productivity.

    However, the true economic burden of injuries is greater than these estimates. Costs associated with lost patient and caregiver time, the nonmedical expenditures incurred by those having to deal with injury and disability, insurance costs, property damage costs, and litigation costs, for example, are not included in these estimates. Additionally, while it is difficult to quantify, the value of life lost to premature mortality, decreased quality of life, and diminished functional capacity might also be included in estimates of the economic impact of injury.

    Both the human costs and the economic costs must be considered when assessing the value of quality trauma care and a regionalized trauma system. While it is becoming widely recognized that trauma centers save lives, effective trauma systems should address the economic impact of injury including the substantial costs resulting from lost wages and productivity. Trauma centers alone will not fully address these costs. Policy makers must understand the role that rehabilitation, job retraining, and injury prevention play in dealing with the tremendous economic impact of this public health issue.

    Some resources for those with additional interest

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