Falls Among Older Adults Pose a Greater Economic Burden Than Firearm Deaths

Falls among older people (≥ 45 years) pose a greater economic burden than firearm deaths in the US, a recent study discovered. The combined cost for fatal falls exceeded firearm injury after 2019.¹

“While public discourse often places an emphasis on issues such as gun violence because of its acuteness, our study underscores the hidden economic burden of geriatric falls,” wrote investigators, led by Bardiya Zangbar, MD, from the Westchester Medical Center in New York.

Fatal firearm injuries are a significant public health concern, with 48,830 Americans dying from gun-related injuries in 2021, according to the US Centers for Disease and Prevention (CDC).² However, with the aging population, senior falls also present a significant concern.¹ Investigators conducted a retrospective study to assess and compare the medical costs of fatal firearm injury and fatal falls during a 5-year period.

The team leveraged data from the online Injury Statistics Query and Reporting database for fatal firearm injuries and falls in patients aged 15 – 85 years. The primary outcome was the medical cost of firearm deaths and falls separately, and the secondary outcome was the combined costs of medical expenses plus the monetary estimate of lost years of life or productivity due to injuries. Fall-related injuries were examined within different age groups.

During the period 2015 – 2020, 230,663 Americans died from falls, with 193,647 cases > 65 years old, and 239,352 died from firearm injury (39,980 > 65 years old).

The study revealed the medical cost of fatal falls (mean cost: $1,427,773,589) was significantly greater in 2015 – 2020 in all groups than firearm injuries ($246,456,666). The percentage of fatal falls had a significant increase in all age ranges, with a rise in the slope in 2019 for patients > 65 years.

Despite this, the combined cost was significantly greater in fatal firearm injuries when compared with fatal falls. However, after adjusting for age, investigators saw the combined cost was greater in fatal falls after 2019 for patients in the 45 – 85+ age range.

“This finding is particularly important since it demonstrates how changing demographics affects the economic burden of healthcare in society,” investigators wrote.

The team explained the combined cost may have been greater for fatal falls after 2019 than for firearm injuries, as victims of firearm injuries often die immediately. In contrast, victims of falls may endure prolonged and more costly hospitalizations and rehabilitation therapy.

The proportion of fatal falls increased from 2015 to 2020, with a significant slope increase after 2019 (annual percent change: 2.81% before 2019 vs 6.95% after 2019). Years of potential life lost were 1,500,900 years for fatal falls and 8,909,758 for firearm injuries.

Investigators acknowledged a survivability bias, noting that firearm injuries are more common among younger individuals, while falls tend to occur more frequently among the elderly. They were also unable to include data on non-fatal firearm injuries in their analysis, as the database did not report the number or associated costs of these cases.

“The increase in fatalities, shifting demographics, and stark economic comparisons between fatal falls and other causes of death underscore the urgency of the issue,” investigators concluded. “Policy makers must recognise geriatric falls as a critical public health challenge and implement proactive measures to prevent falls, provide specialised healthcare, and allocate resources strategically.”

References

1. ^{Zangbar B, Rafieezadeh A, Rodriguez G, et al. Trauma Surg Acute Care Open 2024;9:e001492.}
2. ^{Gramlich, J. What the data says about gun deaths in the U.S. Pew Research Center. April 26, 2024. https://www.pewresearch.org/short-reads/2023/04/26/what-the-data-says-about-gun-deaths-in-the-u-s/. Accessed October 2, 2024.}