As America reels over the horrendous and heart-breaking mass shooting in Las Vegas, researchers from the Johns Hopkins University School of Medicine coincidentally released a disturbing report about firearm-related injuries in the U.S. that showed more than 700,000 patient visits to hospital emergency departments that resulted from shootings (25 per 100,000 people) between 2006 and 2014.

While shooting deaths are the third leading cause of injury-related mortalities in the U.S., the researchers said they performed the extensive study on firearm injuries because they said there was a lack of information about that aspect of gun violence and the economic impact on EDs.

“I think that the major surprise and interesting finding of our study was the immense number of individuals affected by the issue,” Faiz Gani, postdoctoral research fellow at the Johns Hopkins University School of Medicine’s Department of Surgery and lead author.

In the study published in Health Affairs, the researchers cited the “overall incidence” of ED visits for firearm-related injuries for the period 2006-2014, noting it was 25.3 per 100,000 people. That number was “disproportionately higher” in the U.S. than in other higher high-income countries, such as Germany, Japan and the United Kingdom. Gun-related deaths also are higher in the U.S., with about 36,000 reported in 2015, the researchers said.

The victims’ also were studied, with some possibly startling conclusions. Patients injured in suicide attempts, for instance, were more likely to be from highest income groups, people who were assault victims in shootings had low income, the researchers said.

Suicide attempts involving guns were linked more often – twice as high – among Medicare enrollees, compared to patients enrolled in other insurance, they said.

The results showed that the number of “non-fatal” firearm injuries at EDs was 2.4 times of fatal injuries. Such injuries were about nine times more common among men, ages 20 to 24, then women. Since the study did not include people who died before reaching the hospital or did not seek emergency treatment, the researchers acknowledged the increased burden for hospital EDs.

Not surprisingly, the researchers called for greater gun control laws, noting the immense political debate. Adding to the argument over gun control, the researchers said policymakers should consider universal background checks for gun purchases and limiting access for people with histories of violence or previous convictions, which now isn’t always the case.

“I think it’s extremely tragic that we continue to encounter mass shootings today, particularly given that they are potentially preventable to a degree,” Gani told HealthData Buzz following Sunday’s shooting that resulted in the deaths of 58 concert-goers, the gunman himself, and left more than 500 wounded. “I really hope that moving forward we can all come together and adopt a scientific and apolitical approach to gun violence,” he said.

Gani and his colleagues wrote that policymakers – perhaps in an understatement – “might consider implementing universal background checks” for firearm purchases. In addition, gun access should be limited to “people with a history of violence or previous convictions to reduce the clinical and financial burden associated with these injuries,” they wrote.

They acknowledged that “efforts to reduce firearm-related injuries have been limited as a result of the politicized environment surrounding gun violence and a lack of will to consistently implement proposed policies.”

In their study of gun-related injuries, the cost for each injured person treated at an ED was more than $5,000, and $95,000 for inpatient charges; the total was about $2.8 billion annually or $24.9 billion over the study period.

“It was very interesting to note that over 50 percent of our study population was either uninsured or self-pay,” Gani said. “This finding has broad policy implications. While these patients represent the most financially vulnerable patients, they also often do not have any insurance company negotiating on their behalf and therefore often incur the entire financial charge in the form of high pocket expenses.

Other findings:

• Among patients who were shooting victims but treated at EDs, handguns were the most commonly used weapons, 27 percent. Then shotguns, 5.9 percent, or hunting rifles, 2 percent.
• Emergency Care. While there was data that showed reduced shooting related injuries and ED visits for several years, there was an uptick in the most recent year studied, 2014. The incidence of ED admissions for firearm-related injuries decreased from 27.9 ED visits per 100,000 people in 2006 to 21.5 visits in 2013. But there was a “significant increase” in 2014 with 26.6 ED visits per 100,000 people.
• Mental Health Issues. There was an increase in the number of patients “presenting with a diagnosis of a mental health disorder” at EDs stemming from shootings, from 5.3 percent in 2006-2008, to 7.5 percent in 2012-2014. “Of note, the incidence of mental health disorders was highest among patients injured in an attempted suicide, 40.8 percent patients.” the researchers said. While there have been political debate about gun violence and impacts related to people with mental health issues, the discussion might not be so straightforward, they said. “While policy makers have proposed mental health facilities to curtail gun violence, they would likely reduce the number of deaths associated with mental health disorders, but would have a limited impact on the overall burden of firearm-related injuries, given the small share of patients with such injuries,” the researchers said.

Despite all the debate over guns, research in the field is not funded where it should be – and that’s because of politics, they said.

“Research has been limited due to the politicized nature of this and the lack of appropriate funding despite the high clinical and financial burden associated with this issue,” they added.

As their study was published in in a week of turmoil for the country on gun-related violence, Gani observed: “I hope that our study coupled with work from other gun violence researchers furthers the conversation of gun violence through the use of robust evidence.”

“Only after we understand the complex factors at play can we develop appropriate and effective policies that ensure that we aren’t’ having the same conversation again in a few months,” he said.  — Joe Cantlupe