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Tuesday, October 7, 2014

Costs of Injuries to Motor Vehicle Occupants

The health burden and medical costs resulting from nonfatal crash injuries in the United States are substantial. In 2012, an estimated 2.5 million ED visits occurred because of such injuries, of which approximately 188,000 were serious enough to require hospitalization. This is equivalent to 6,902 ED visits and 517 hospitalizations every day. With U.S. households averaging 5.7 vehicle trips per day, the risk for these injuries is widespread.
Motor vehicle crashes result in substantial mortality and years of potential life lost. This study shows that the nonfatal injury burden is also high. For each motor vehicle occupant killed in a crash in 2012, eight were hospitalized, and 100 were treated and released from the ED. The estimated lifetime medical cost of nonfatal crash injuries is similar to other serious, but perhaps more well-known, public health problems. For example, the estimated lifetime medical cost of crash injuries is approximately 50% higher than the estimated $12.6 billion cost for human immunodeficiency virus (HIV) in the United States . On average, each crash-related ED visit costs $3,362, and each hospitalization costs $56,674.
These nonfatal crash injury costs can create both an immediate and lifelong burden for individuals and their families, as well as employers, and public and private healthcare payers. Although these are lifetime medical costs, the majority of medical costs (approximately 75%–90%) are estimated to occur in the first 18 months after the crash . In addition to the burden of medical costs, crash injuries cause a substantial lost lifetime productivity valued at $32.9 billion.
Teens and young adults aged 15–29 years accounted for a disproportionate share of the burden, comprising 21% of the population but accounting for 38% of both the treated and released visits and costs in this analysis. Other studies have shown that this age group has a higher prevalence of risk factors for crash injuries. In 2012, teens and young adults aged 16–24 years had the lowest prevalence of observed restraint use (80%) compared with all other age groups (87%–88%). In 2010, adults aged 21–24 years and 25–34 years had the highest self-reported prevalence of driving after having had too much to drink (3.6% and 2.6%, respectively) compared with adults aged 18–20 years (2.2%) and adults aged ≥35 years (0.8%–1.9%).
Older adults in this study were more likely to be hospitalized for a crash injury compared with other age groups. Increased frailty, rather than increased risk for crash involvement, likely accounts for the majority of increased fatality risks for adults aged ≥60 years, and might explain the increased proportion of ED visits that result in hospitalization among this age group.
Analyses of risk factors such as non use of restraints, alcohol use, and geographic location were not possible in this study. Although the Fatality Analysis Reporting System has national and state-level information on motor vehicle crash fatalities, including factors contributing to the crash, no single data source exists for risk factors and associated medical outcomes for nonfatal crash injuries. Also, the completeness of external cause-of-injury coding in existing state-based hospital discharge and ED data systems varies, making it difficult to monitor and assess motor vehicle crash injuries treated in hospitals in some state and local jurisdictions
This analysis suggests that states, employers, and individuals can avert substantial medical costs by adopting safety practices and policies shown to protect motor vehicle occupants. Primary seatbelt laws, child passenger restraint laws, ignition interlocks to prevent alcohol impaired driving, publicized sobriety checkpoints, and graduated driver licensing systems for teens all have demonstrated effectiveness to reduce crash injuries and fatalities
These interventions reduce injuries and result in economic savings. For instance, an estimated 54,000 serious injuries could be prevented annually if all occupants wore seatbelts, and 82,000 serious injuries could be prevented if all drivers had a blood alcohol content of <0.08 g/dL . The 2009 passage of a primary seat belt law in Minnesota is estimated to have increased seat belt use and averted $45 million in hospital charges, or roughly an estimated $36 million in hospital costs over a 2-year period . The presence of graduated driver licensing laws is associated with reduced injuries and reduced cost for private and public payers. A $30 booster seat is estimated to save an average of $245 in medical costs over 4 years of use). Finally, publicized sobriety checkpoint programs show benefit-cost ratios ranging from 2:1 to 57:1 . To date no state has implemented all of these safety measures in accordance with evidence and expert recommendation.

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