UI study looks at hospitalization costs associated with gun injuries

Hospitalization costs associated with gun injuries in the U.S. exceeded $622 million a year, according to a new study by the University of Iowa College of Public Health.

“These findings demonstrate the high health care cost burden of firearm injuries,” says Corinne Peek-Asa, lead author of the study and professor of environmental and occupational health in the UI College of Public Health. “Efforts to prevent these injuries, particularly assaults and injuries caused by handguns, could reduce this cost burden.”

As an example of the high cost to taxpayers and the health care system, Peek-Asa points to the finding that 57 percent of all firearm hospitalization costs were either paid by Medicaid—at more than $205 million—or not paid at all, as uninsured victims accounted for $155 million of the costs.

The study looked at the National Inpatient Sample, the nation’s leading database on estimating outcomes related to hospital admissions, to examine hospitalizations due to firearm injuries between 2003 and 2013. The researchers looked only at costs associated with the immediate hospitalization after a gun injury for this study, and did not consider associated costs after the victim’s discharge.

The study notes that $622 million represents less than 1 percent of the overall $377 billion costs for hospital stays annually. But firearm injuries are significantly more expensive to treat than many other causes of hospitalization. The cost of an average hospital stay during the study period was $10,400, while the stay for firearm injuries cost $17,000 to $33,400, on average, depending on the incident that led to the injury.

The study found 336,785 hospital admissions as a result of a firearm injury during the study period, an average of more than 30,000 per year. More than 60 percent of those admissions were the result of assaults, and of those, 70 percent were caused by a handgun. Assaults also accounted for the greatest share of the health care costs, at $389 million.

The study also found 23 percent of gun injuries were accidental and 9 percent were suicide attempts or other types of self-harm.

Among firearms injuries, assault weapons had the highest cost per admission, at more than $32,000 per injury. The highest total annual cost was for admissions with an unknown type of firearm, at $373 million, which Peek-Asa says indicated a need for improved data collection.

Other findings in the study:

  • More than 80 percent of firearm injury hospitalizations were among individuals age 15 to 44, with the highest annual rate of 28.9 per 100,000 among those age 15 to 24.
  • The injury rate for males was 18.2 per 100,000, 2.1 per 100,000 for females.
  • The injury rate for African Americans was 39.7 per 100,000, while the race category of “other,” which includes primarily those with multiple ethnicity designations, was 21.1 per 100,000. The rate for whites was 4.4 per 100,000.

The study, “Cost of Hospitalization for Firearm Injuries by Firearm Type, Intent, and Payer in the United States,” was co-authored by Brandon Butcher, UI graduate student in biostatistics, and Joseph Cavanaugh, professor of biostatistics, both in the UI College of Public Health. It was published in the current issue of the journal Injury Epidemiology and is available at https://www.ncbi.nlm.nih.gov/pubmed/28721637.

Additional Media Coverage

University of Iowa study: Gun injuries exceed $622 million in hospitalizations each year (The Gazette)
http://www.thegazette.com/subject/news/health/university-of-iowa-study-gun-injuries-exceed-622-million-in-hospitalizations-each-year-20170828

Gun injuries amount to $622M in US hospitalization costs annually (Becker’s Hospital Review)
http://www.beckershospitalreview.com/finance/gun-injuries-amount-to-622m-in-us-hospitalization-costs-annually.html

Iowa study finds gun injuries exceed $622 million in hospitalizations (Quad City Times)
http://qctimes.com/news/state-and-regional/iowa/iowa-study-finds-gun-injuries-exceed-million-in-hospitalizations/article_3d34ec86-1441-5fcc-8d77-2576fb288706.html

Editorial: Taxpayers foot bill for gun violence (Des Moines Register)
http://www.desmoinesregister.com/story/opinion/editorials/2017/08/29/editorial-taxpayers-foot-bill-gun-violence/612084001/

Gun injuries exceed $622 million in hospitalizations each year: UI study (SouthernMinn.com)
http://www.southernminn.com/around_the_web/news/article_120150d9-15ed-5af0-921f-9dfcb4094107.html

Medicaid and hospitals pick up the bill for the majority of gunshot victims
http://www.businessinsider.com/medicaid-and-hospitals-pay-for-the-majority-of-gunshot-victims-2017-9

Private Insurance Pays a Tiny Fraction of Gunshot-Victim Health Costs
https://www.thetrace.org/2017/08/gunshot-victims-health-care-costs-private-insurance/

Peek-Asa selected for Big Ten Academic Leadership Program

A portrait of Corinne Peek-Asa, Associate Dean for Research and Professor of Occupational and Environmental Health at the University of Iowa College of Public Health.Corinne Peek-Asa, University of Iowa professor of occupational and environmental health and associate dean for research in the College of Public Health, has been named a Fellow in the 2017–18 Big Ten Academic Alliance Academic Leadership Program.

Established in 1989, the Academic Leadership Program (ALP) is one of the longest-serving professional development programs offered by the Big Ten Academic Alliance. This intensive experience develops the leadership and managerial skills of faculty who have demonstrated exceptional ability and academic promise. The program is specifically oriented to address the challenges of academic administration at major research universities and to help faculty members prepare to meet them.

The primary goal of the program is to help a select group of talented and diverse faculty further develop their ability to be effective academic leaders at all levels of research universities. Since its inception over 1,400 participants have completed the program.

The ALP Fellows attend three campus-based seminars, each three days in length, and participate in related activities on their home campuses between seminars. The seminars are rotated among Big Ten member institutions. Host campuses for the 2017-18 program are the University of Iowa, the University of Michigan, and the University of Nebraska-Lincoln.

 

Iowa Health by the Numbers

images of sculpted numbers“Numbers have an important story to tell. They rely on you to give them a voice.”
– Stephen Few, information design educator and author

 

There’s no shortage of public health challenges to tackle, from long-standing concerns like heart disease and obesity to more recent issues such as opioid addiction and Zika virus.

To make the best choices about where to allocate limited resources, public health practitioners, policymakers, hospital administrators, and other health providers need solid, well-researched information to help guide decisions. Data is not only essential for deciding where to concentrate efforts, but also to inform and advance health policy in the form of regulations, guidelines, and budget priorities.

Many other professionals rely on public health data to support their work: researchers to track health trends, grant writers to complete their applications, community organizers to plan activities, journalists to highlight health issues, and many others.

Several centers based in the College of Public Health produce rich sources of Iowa-specific health data, the collection and storage of which is carefully managed to maintain confidentiality and security. Three online resources of Iowa health data are spotlighted in the following pages.

Iowa Health Fact Book

iowahealthfactbook.org

What percentage of Iowa’s 11th graders smoke cigarettes? How many family practice physicians are there in Sioux County? Is heart disease mortality rising or falling in the state?

The answers to these and a plethora of other public health questions can be found in the Iowa Health Fact Book, a free online resource compiled by the University of Iowa College of Public Health, Iowa Department of Public Health, and other partners.

The Fact Book web site provides information for each of Iowa’s 99 counties and, where possible, includes demographics and vital statistics, data on disease incidence and mortality, health and social determinants of health, health resources, and environmental factors. The information is searchable and available publicly to researchers, public health practitioners, policymakers, and anyone else needing Iowa-specific health facts.

403 mumps cases in IowaPreviously, the Iowa Health Fact Book had been produced in book form and updated every two years. In its new online form, the information is now updated as new statistics become available and is fully searchable by county or aspects of health, such as cancer, infectious diseases, and health care facilities.

“We’re excited about how this new web site will make it easier for users to browse and summarize the data that is specific to their county,” says Jacob Oleson, director of the Center for Public Health Statistics. “Whenever possible, we’ve included the same types of information in the same tabular and graphical format as in the past.”

With ongoing updates, the Fact Book allows for the presentation of data longitudinally, giving a picture of the changing Iowa health landscape, Oleson adds.

“As we continue this effort over the years, we are in a better position to track changes, measure progress, and identify areas of weakness,” Oleson says.

In addition to the UI College of Public Health and Iowa Department of Public Health, contrib­utors to the Iowa Health Fact Book include the Iowa Department of Inspections and Appeals, Iowa Registry for Congenital and Inherited Disorders, Iowa State Trauma Registry, State Health Registry of Iowa/Iowa Cancer Registry, Office of Statewide Clinical Education Programs, Iowa Health Professions Tracking Center, University of Iowa Information Technology Services, Iowa Consortium for Substance Abuse Research and Evaluation, National Center for Health Statistics – U.S. Centers for Disease Control and Prevention, and U.S. Census Bureau.

Burden of Injury in Iowa

cph.uiowa.edu/iprc/resources/

11.444 hospitals beds in iowaInjuries are a major public health concern that affects all Iowans, regardless of age, race, or gender. However, the distribution of the cause, intent, and type of these injuries varies greatly throughout Iowa’s 99 counties, depending on their population demographics and other factors.

The Burden of Injury in Iowa report, produced as a partnership of the UI Injury Prevention Center (IPRC) and the Iowa Department of Public Health, provides statewide rates of injury deaths and non-fatal hospitalizations for all types of injuries, as well as information on the specific burden of injury in each county of Iowa.

With the most recent data presented in an interactive map, users can click on a county to view its corresponding information. Previous reports are also available in PDF format.

“Injuries are preventable,” says Corinne Peek-Asa, director of the IPRC. “The Burden of Injury in Iowa report has been used extensively by both local health departments and agencies to prioritize injury programs and promote the need for injury prevention throughout the state.”

Efforts to reduce the burden of injuries are most effective when they are tailored to the specific injury burden and the needs of the target population, Peek-Asa adds. She encourages communities, health practitioners, and local policymakers to use the report to develop strategies and policies to reduce injuries.

The report is based on death certificate information from the Iowa Department of Public Health, as well as hospitalization data from the Iowa Hospital Association hospital inpatient discharge data.

State Health Registry of Iowa

cph.uiowa.edu/shri/

In 2017, the State Health Registry of Iowa, also known as the Iowa Cancer Registry, will collect data on an estimated 17,400 new cancers among Iowa residents. Investigators at the Iowa Cancer Registry also estimate that 6,200 Iowans will die from cancer in 2017, 18 times the number caused by auto fatalities.

These estimates are based on mortality data the Iowa Cancer Registry receives from the Iowa Department of Public Health. The registry has been gathering cancer incidence and follow-up data for Iowa since 1973 and is one of fourteen population-based registries and three supplementary registries nationwide providing data to the National Cancer Institute.

Each year, the registry releases the Cancer in Iowa report, which provides county-by-county statistics for new cancer cases and cancer deaths, as well as an estimate of the top 10 types of new cancer and cancer deaths for males and females in Iowa for the coming year. Available online, the 2017 report also includes a special section highlighting liver cancer, which is increasing in Iowa, particularly among the “baby-boomer” population; summaries of current research projects; and a selected list of publi-cations produced during the previous year.

17,4000 estimated new cancers in Iowa in 2017The registry web site also houses an interactive map that provides cancer incidence rates and cancer morality in Iowa going back to 1973. The data is searchable by county, cancer site, gender, race/ethnicity, and other parameters.

“The registry makes this data available so health providers, health departments, and cancer organizations can track progress and determine areas of need,” says Mary Charlton, assistant professor of epidemiology and an investigator with the Iowa Cancer Registry.

In addition to reporting on cancer incidence, survival, and mortality among Iowans, the registry responds to requests from individuals and organizations in the state of Iowa for cancer data and analyses, and provides data and expertise for cancer research activities and educational opportunities.

In 2017, the registry is participating in more than 75 studies, including the Agricultural Health Study, a long-term study of agricultural exposures (including pesticides) and chronic disease—especially cancer—among commercial or private pesticide applicators (and their spouses, if married) in Iowa and North Carolina. Now in its 24th year, the study is funded through the National Cancer Institute and involves several federal agencies.

Registry data are also being used to evaluate the treatment received for a first cancer and the risk it places on the patient for development of a second cancer, to monitor the impact of the Human Papillomavirus Virus (HPV) vaccine on HPV types in cancers, and to research the association between organ transplantation and elevated cancer risks.

This story originally appeared in the spring 2017 issue of InSight.

Research: Farmers still take own lives at a high rate

The number of suicides among farmers and farmworkers in the United States has remained stubbornly high since the end of the 1980s farm crisis, much higher than workers in many other industries, according to a new study from the University of Iowa.

The study examined suicides and homicides among farmers and agricultural workers across the country from 1992 to 2010 and found 230 farmers committed suicide during that time, an annual suicide rate that ranged from 0.36 per 100,000 farmers to 0.95 per 100,000. The rate is well above that of workers in all other occupations, which never exceeded 0.19 per 100,000 during the same time period.

The 1992 to 2010 rate is not as high as the 1980s, when more than 1,000 farmers took their own lives because they were losing their farms to foreclosure, but study co-author Corinne Peek-Asa, professor of occupational and environmental health in the UI College of Public Health, says the new numbers still are excessive.

“Occupational factors such as poor access to quality health care, isolation, and financial stress interact with life factors to continue to place farmers at a disproportionately high risk for suicide,” she says.

The survey found farmers in the West were more likely to commit suicide, at 43 percent of total farmer suicides, followed by the Midwest (37 percent), South (13 percent), and Northeast (6 percent).

As in the 1980s, financial issues continue to cause some suicides, especially during economic crises or periods of extreme weather, Peek-Asa says. But farmers face an array of other stresses that put them at high risk for suicide: physical isolation from a social network, leading to loneliness; physical pain from the arduous work of farming; and lack of available health care resources in rural areas, especially mental health care. She says other research also suggests that exposure to chemical insecticides causes depression in some people.

In addition, Peek-Asa says, farm culture dictates that farmers who may have physical or psychological needs should just suck it up and go about their work.

Finally, farmers have access to lethal means because many of them own weapons. The rifle they use to chase off coyotes can easily be turned on themselves.

Peek-Asa says farmers are different from workers in most other fields in that their work is a significant part of their identity, not just a job. When the farm faces difficulties, many see it as a sign of personal failure.

“They struggle with their ability to carve out the role they see for themselves as farmers. They can’t take care of their family; they feel like they have fewer and fewer options and can’t dig themselves out,” Peek-Asa says. “Eventually, suicide becomes an option.”

Peek-Asa says policy solutions would include include improving rural economies, increasing social networks in rural areas, and improving access to health care and mental health services in rural areas.

Beyond that, she says improving the quality of life in rural communities also is important, pointing to UI programs that contribute to that, such as the mobile museum or Hancher’s summer art outreach program that brings arts and cultural opportunities to towns and cities across Iowa.

The study, “Trends and Characteristics of Occupational Suicide in Farmers and Agriculture Workers,” was published in the Journal of Rural Health. It was co-authored by Kelley Donham, UI professor emeritus in the College of Public Health; Marizen Ramirez of the University of Minnesota and visiting associate professor in the UI College of Public Health; and Wendy Ringgenberg of Des Moines University.

(This story originally appeared in Iowa Now)

Additional Media Coverage

Iowa Public Radio River to River
http://iowapublicradio.org/post/suicide-rates-still-stubbornly-high-among-farmers

KCRG
http://www.kcrg.com/content/news/Study-Ag-workers-commit-suicide-at-higher-rate-428286583.html

Health Day, US News & World Report
http://health.usnews.com/health-care/articles/2017-06-21/suicide-risk-especially-high-for-us-farmers

Radio Iowa
http://www.radioiowa.com/2017/06/13/study-shows-suicide-rates-among-farmers-remain-higher-than-other-occupations/

Norfolk Daily News
http://norfolkdailynews.com/wjag/news/study-farmer-suicide-rates-continue-to-climb/article_838040b0-5ff4-11e7-9615-ff23cf124595.html

Cedar Rapids Gazette
http://www.thegazette.com/subject/news/ag-workers-face-higher-suicide-rate-than-other-workers-20170704

EurekAlert
https://www.eurekalert.org/pub_releases/2017-06/uoi-la1061217.php

Ag Daily
http://www.agdaily.com/news/university-iowa-farmer-suicides-high-1980s-farm-crisis/

Business Standard – India
http://www.business-standard.com/article/pti-stories/occupational-and-life-factors-behind-farmer-suicides-us-study-117061300800_1.html

Financial Express – India
http://www.financialexpress.com/world-news/occupational-and-life-factors-behind-farmer-suicides-us-study/716235/

How Stuff Works
http://health.howstuffworks.com/mental-health/depression/facts/farmers-suicide-rate-high-study.htm

Asian Age
http://www.asianage.com/india/all-india/180617/is-pm-modi-listening-to-the-anguish-of-farmers.html

Indiana Ag Connection
http://www.indianaagconnection.com/story-national.php?Id=1253&yr=2017

Nebraska Radio Network
https://nebraskaradionetwork.com/2017/07/03/study-farmer-suicide-rates-continue-to-climb/

Farms.com
http://www.farms.com/ag-industry-news/farmer-and-farmworker-suicide-rates-remain-high-in-the-u-s-according-to-university-of-iowa-study-073.aspx

The Daily Iowan
http://daily-iowan.com/2017/07/20/farmers-most-at-risk-for-suicide-among-workers/

Peek-Asa, Thorne honored at Celebrating Excellence awards

Peter Thorne, Sue Curry, and Corinne Peek-Asa
Peter Thorne, Interim Provost Sue Curry, and Corinne Peek-Asa

Recognizing a year of innovation, scholarship and service, the University of Iowa Celebrating Excellence: Discovery and Innovation Awards Ceremony was held April 24.

The annual event honors faculty, staff, post-doctoral fellows, undergraduates and graduate students, and mentors who have demonstrated outstanding accomplishments in their fields. It also recognizes faculty, staff and student innovators who launch their research findings out into startups, options and/or licenses.

The winners received a commemorative gift and cash award.

College of Public Health recipients were:

Scholar of the Year Award: Recognizes outstanding research, scholarly and/or creative activities by tenured and/or research/clinical track faculty members

  • Peter S. Thorne, Ph.D., Professor and Head, Occupational & Environmental Health, Environmental Health Sciences Research Center, College of Public Health

Faculty Communicating Ideas Award: Recognizes excellence in communication about research and scholarship in the sciences and humanities and the study of creative, visual and performing arts to a general audience directly or via print and electronic media.

  • Corinne Peek-Asa, Ph.D., Professor/Associate Dean for Research, Department of Occupational and Environmental Health, College of Public Health

See a full list of award recipients.