From broken bones to concussions, injuries afflict millions across the United States. While some may appear common and of minimal consequence in the long term, they can quickly drain individuals’ pockets and well-being. In response, Associate Professor of Emergency Medicine and Pediatrics Mark Zonfrillo ’99 MD ’03 led a study that determined the costs and prevalence of nonfatal injuries. The study uniquely aimed to quantify and break down not only the financial burden of medical spending but also the impact from job loss and quality of life. Using statistics from 2013, the study found that the 31 million nonfatal injuries from that year cost about $1.853 trillion, with over a trillion of that amount stemming from a decrease in quality of life.
Looking at the results, the $1.8 trillion is “an astronomical value,” Zonfrillo said. “If you think about the injuries occurring to all U.S. citizens in one year and the sort of lifetime cost as the result of those injuries, it is profound.” The results also illustrated that nonfatal injuries are common issues, affecting about one in every 10 people annually in the United States.
The analysis of nonfatal injuries contributes to the study’s significance. “Deaths are just the tip of the pyramid when it comes to the burden of injuries,” wrote Abdulgafoor Bachani, assistant professor of international health at Johns Hopkins University, in an email to The Herald. He was not involved in this study but has done research on the socioeconomic and health-related effects of injuries in nations with lower average incomes than the United States.
While the study was published in October, analysis of the data began around February 2017, Zonfrillo said. The team collected data from injured patients across emergency department visits and hospitalizations and surveyed the medical reports to classify the injuries. In recent years, the number of states classifying injuries has increased, which gave the team better data for their analysis, said Bruce Lawrence, a research scientist at the Pacific Institute for Research and Evaluation and a co-author of the study.
Assessment of the decrease in quality of life also set this study apart. While the U.S. government has only recently tried to perfect a method of quantifying quality of life, the team tried to put this methodology to use for its analysis, which allowed researchers to obtain a more holistic picture of the financial impact of injuries, beyond traditional metrics.
The statistics for the study were five years old, but Zonfrillo said more recent data would not be significantly different.
Even with the study’s improved methodology, the $1.8 trillion price tag may not encapsulate the full cost of nonfatal injuries. Traumatic brain injuries and spinal cord injuries — the most costly categories studied — cause long-term consequences and their financial impacts are difficult to quantify. “Because the impact (of TBI and spinal cord injuries) is lifelong, it’s hard for any one study to get at the full impact. You have to follow a patient for so many years that it’s hard to study,” Lawrence said.
Zonfrillo has prior experience with research on injury epidemiology, and the repercussions of injuries encouraged him to conduct the study in the first place. Noticing the preventability and cost of nonfatal injuries, he hopes that his work will help decrease their prevalence in the United States. “(Injuries are) one of the leading causes of death and disability (in) people of all ages, and they’re very costly,” he said. But educational initiatives, economic incentives, enforcement of policy measures and engineering can all help prevent injuries.
In the past, similar research has influenced legislation. “Most dangerous products tend to bring policy responses to make them safer,” Zonfrillo said. The U.S. Consumer Product Safety Commission has used injury cost analyses to identify harmful products and address their dangers, he added. Finding solutions is not easy, however; falls — the primary cause of injuries nationally, with over eight million cases in 2013 — vary so widely in type and root cause that creating a common means of prevention is challenging.
Going forward, Lawrence believes the results from this study may help governments decide which injuries should command their attention and resources. “From a policy standpoint, (the data) would help government officials in charge of health and safety policy when they’re determining where to put their emphasis with respect to different types of health problems,” he said. “They could use this information to compare to other health problems.”
Bachani also believes that approaching the problem through economics “can assist us in making a better case for more investments in injury prevention interventions and programs that are very cost-effective compared to other public health interventions,” he added in his email to The Herald.