Two-Year Utilization and Expenditures for Children After a Firearm Injury.
Two-Year Utilization and Expenditures for Children After a Firearm Injury.
复制标题
枪伤后儿童的两年利用和支出。
DOI：
10.1016/j.amepre.2022.07.007
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发表时间：
2022
影响因子：
5.5
通讯作者：
Fleegler,EricW
中科院分区：
文献类型：
--
作者：
Pulcini,ChristianD;Goyal,MonikaK;Hall,Matt;DeSouza,HeidiGruhler;Chaudhary,Sofia;Alpern,ElizabethR;Fein,JoelA;Fleegler,EricW
枪支伤害是儿童发病的主要原因，但关于伤害后医疗保健利用和支出的数据有限。本研究旨在分析非致命火器伤害后2年的医疗保健遭遇和支出。方法采用回顾性队列研究方法，于2020年至2022年对2010年至2016年在Medicaid MarketScan索赔数据库中使用《国际疾病分类第九版》/ICD-10枪支伤害诊断代码的0-18岁儿童进行回顾性队列研究。结果包括医疗保健就诊和支出的差异，包括心理健康。描述性统计描述了患者人口统计学特征和医疗保健利用情况。用Wilcoxon符号秩检验评价卫生支出的变化。结果911例儿童中，指数火器伤发生前一年共就诊12757次，发生后一年就诊155481次（p< 0.001），第二年就诊10228次（p< 0.001）。与此同时，在火器伤害发生一年后，医疗支出总体增加了1440万美元（每位患者11415美元）（p< 0.001），而在火器伤害发生两年后，医疗支出减少了80万美元（p= 0.001）。先前支出低的儿童（大多数样本）在受伤后的第二年持续增加。在枪支伤害后2年的儿童中，心理健康的利用和支出分别有31%和37%的绝对下降。结论：经历非致命性火器伤害的儿童在火器伤害后一年的医疗保健接触次数和医疗保健支出增加，这种情况不会持续到第二年。心理健康的利用和支出在火器伤害后2年内仍然下降。需要对与非致命性火器伤害相关的发病率进行更多的纵向研究。
Introduction Firearm injuries are a leading cause of morbidity among children, but data on healthcare utilization and expenditures after injury are limited. This study sought to analyze healthcare encounters and expenditures for 2 years after a nonfatal firearm injury. Methods A retrospective cohort study was conducted between 2020 and 2022 of children aged 0–18 years with International Classification of Diseases, Ninth Revision/ICD-10 diagnosis codes for firearm injury from 2010 to 2016 in the Medicaid MarketScan claims database. Outcomes included the difference in healthcare encounters and expenditures, including mental health. Descriptive statistics characterized patient demographics and healthcare utilization. Changes in health expenditures were evaluated with Wilcoxon sign rank tests. Results Among 911 children, there were 12,757 total healthcare encounters in the year before the index firearm injury, 15,548 1 encounters in the year after (p< 0.001), and 10,228 total encounters in the second year (p< 0.001). Concomitantly, there was an overall increase of $14.4 million in health expenditures ($11,415 per patient) 1 year after (p< 0.001) and a $0.8 million decrease 2 years after the firearm injury (p= 0.001). The children with low previous expenditures (majority of sample) had sustained increases throughout the second year after injury. There was a 31% and 37% absolute decrease in mental health utilization and expenditures, respectively, among children 2 years after the firearm injury. Conclusions Children who experience nonfatal firearm injury have an increased number of healthcare encounters and healthcare expenditures in the year after firearm injury, which is not sustained for a second year. Mental health utilization and expenditures remain decreased up to 2 years after a firearm injury. More longitudinal research on the morbidity associated with nonfatal firearm injuries is needed.