Hospital emergency rooms saw more than 700,000 shooting victims last decade

As hospitals in Las Vegas deal with hundreds of shooting victims, a new study finds that gun violence sent more than 700,000 patients to emergency rooms in less than a decade. Those visits resulted in nearly $25 billion spent in healthcare over that period.

Local officials reported that hospitals in Las Vegas were treating 515 casualties and that 58 people were dead after a gunman opened fire from the 32nd floor of the Mandalay Bay Resort Hotel late Sunday night.

Firearm-related injuries accounted for 25.3 emergency department visits for every 100,000 people between 2006 and 2014, according to an analysis of government data published Monday in Health Affairs and released to the press on an embargo before Sunday's shooting. Costs associated with the care of those patients during that period totaled $2.9 billion in ED charges and $22 billion for inpatient care.

The study sheds light on a corner of public health that's lacking public data to truly estimate the scope of the epidemic.

A study published in March in the American Journal of Public Health summarized the cost of shooting-related hospitalizations at more than $6 billion between 2006 and 2014. The annual expense was $700 million.

But while advances in technology and improved clinical care are saving more lives, the cost of maintaining care and comfort after a shooting has increased.

Study co-author Dr. Faiz Gani, a postdoctoral research fellow in the Johns Hopkins School of Medicine's department of surgery, acknowledged that the study's cost estimates were most likely conservative if all of the underlying medical needs that are often a part of a gunshot victim's recovery were ever considered. Such issues can include recurring visits to a hospital due to post-operative complications, physical rehabilitation, mental health supports, and the potential of those victims of gun violence being shot again.

"I think we're really just at the tip of the iceberg here," Gani said. "I think it's far, far more than we are able to capture right now in terms of the financial and clinical burden."

The study found that the average emergency department charge was $5,254 per person, while inpatient per patient costs averaged $95,887. Men were nine times more likely to be shot than women. Adults ages 20-24 had the highest rate of ED utilization for gunshot wounds at 85.7 visit for every 100,000 people.

Patients who died during an ED visit had the highest ED charges on average at $11,463, accounting for 11% of total ED costs. The highest charges were among patients who visited an ED, were admitted, and were in need of additional care. The average cost per those patients was more than $179,000.

Earlier this year, the Urban Institute studied the cost of treating gun violence at hospitals in six states from 2010 to 2014. The average hospital cost per patient ranged from $9,000 to $18,000 among the states studied. It found that because of the average population makeup of the victims, early Medicaid expansion adopters such as Kentucky saw uncompensated care for gun victims fall from 54% to 13% over that period, with Medicaid accounting for 68% of coverage.

The study's findings contradict arguments on both sides of the debate over gun-control measures.

Many gun advocates contend that the problem of gun violence is best addressed by putting more resources into addressing access to behavioral healthcare services. Proponents for stricter gun ownership laws have called for bans on assault rifles. But both factors accounted for only a fraction of the ED visits that occurred due to firearm injuries.

More than 40% of the injuries that involved patients who were found to have a mental health disorder were caused by an attempted suicide; those incidents made up 5% of all firearm-related ED visits.

"While it might reduce the number of overall deaths from firearms, the overall number of incidents would be impacted very little by improving access to mental healthcare," Gani said. "Improving access to mental healthcare is really important, but I think at the same time we need active legislation or policies that address the larger scope of the problem."

Likewise, patients who came to the ED with a firearm injury were most likely to have been shot by a handgun, which accounted for 27% of all cases, while assault rifles made up just 2%.

"I think that while that's probably important from the aspect of mass shootings, I think it doesn't address the actual burden because a lot of the injuries that occur are due to either a handgun or a shotgun," Gani said.

Gani said much is still unknown about the total societal costs associated with gun violence because research on the subject—as well as examining ways to make guns safer—has been largely blocked for years by congressional Republicans who have effectively banned federal funding for gun-violence research since 1996.

On Monday, President Donald Trump led a moment of silence for the victims of Sunday's shooting in Las Vegas and said he would fly to the city on Wednesday. But neither he, nor the White House spoke of any legislative action in the wake the country's largest mass shooting.