Publications by authors named "Cora Peterson"

42 Publications

Do out-of-pocket costs influence retention and adherence to medications for opioid use disorder?

Drug Alcohol Depend 2021 Aug 21;225:108784. Epub 2021 May 21.

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.

Background: Availability of medications for opioid use disorder (MOUD) has increased during the past two decades but treatment retention and adherence remain low. This study aimed to measure the impact of out-of-pocket buprenorphine cost on treatment retention and adherence among US commercially insured patients.

Methods: Medical payment records from IBM MarketScan were analyzed for 6,439 adults age 18-64 years with commercial insurance who initiated buprenorphine treatment during January 1, 2016 to June 30, 2017. Regression models analyzed the relationship between patients' average daily out-of-pocket buprenorphine cost and buprenorphine retention (at least 80 % days covered by buprenorphine) at three different thresholds (180, 360, and 540 days) and adherence (the number of days of buprenorphine coverage) within each retention threshold. Models controlled for patient demographic and clinical characteristics including age, sex, presence of other substance use disorders, psychiatric and pain diagnoses, and receipt of prescription medications.

Results: A one dollar increase in daily out-of-pocket buprenorphine cost was associated with a 12-14 % decrease in the odds of retention and a 5-8 % increase in the number of days without buprenorphine coverage during each analyzed retention threshold.

Conclusion: Recent policies have attempted to address supply-side barriers to MOUD treatment. This study highlights patient cost-sharing as a demand-side barrier to MOUD. While the average out-of-pocket buprenorphine cost is lower than two decades ago, this study suggests even at current levels such costs decrease retention and adherence among commercially insured patients. Efforts to address demand-side barriers could help maximize the health and social benefits of buprenorphine-based MOUD.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108784DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8314254PMC
August 2021

Assessment of Annual Cost of Substance Use Disorder in US Hospitals.

JAMA Netw Open 2021 03 1;4(3):e210242. Epub 2021 Mar 1.

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.

Importance: A persistently high US drug overdose death toll and increasing health care use associated with substance use disorder (SUD) create urgency for comprehensive estimates of attributable direct costs, which can assist in identifying cost-effective ways to prevent SUD and help people to receive effective treatment.

Objective: To estimate the annual attributable medical cost of SUD in US hospitals from the health care payer perspective.

Design, Setting, And Participants: This economic evaluation of observational data used multivariable regression analysis and mathematical modeling of hospital encounter costs, controlling for patient demographic, clinical, and insurance characteristics, and compared encounters with and without secondary SUD diagnosis to statistically identify the total attributable cost of SUD. Nationally representative hospital emergency department (ED) and inpatient encounters from the 2017 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample and National Inpatient Sample were studied. Statistical analysis was performed from March to June 2020.

Exposures: International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) principal or secondary SUD diagnosis on the hospital discharge record according to the Clinical Classifications Software categories (disorders related to alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives, stimulants, and other substances).

Main Outcomes And Measures: Annual attributable SUD medical cost in hospitals overall and by substance type (eg, alcohol). The number of encounters (ED and inpatient) with SUD diagnosis (principal or secondary) and the mean cost attributable to SUD per encounter by substance type are also reported.

Results: This study examined a total of 124 573 175 hospital ED encounters and 33 648 910 hospital inpatient encounters from the 2017 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample and National Inpatient Sample. Total annual estimated attributable SUD medical cost in hospitals was $13.2 billion. By substance type, the cost ranged from $4 million for inhalant-related disorders to $7.6 billion for alcohol-related disorders.

Conclusions And Relevance: This study's results suggest that the cost of effective prevention and treatment may be substantially offset by a reduction in the high direct medical cost of SUD hospital care. The findings of this study may inform the treatment of patients with SUD during hospitalization, which presents a critical opportunity to engage patients who are at high risk for overdose. Aligning incentives such that prevention cost savings accrue to payers and practitioners that are otherwise responsible for SUD-related medical costs in hospitals and other health care settings may encourage prevention investment.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.0242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7936257PMC
March 2021

Systematic Review of Violence Prevention Economic Evaluations, 2000-2019.

Am J Prev Med 2021 04 16;60(4):552-562. Epub 2021 Feb 16.

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.

Context: Health economic evaluations (e.g., cost-effectiveness analysis) can guide the efficient use of resources to improve health outcomes. This study aims to summarize the content and quality of interpersonal violence prevention economic evaluations.

Evidence Acquisition: In 2020, peer-reviewed journal articles published during 2000-2019 focusing on high-income countries were identified using index terms in multiple databases. Study content, including violence type prevented (e.g., child abuse and neglect), outcome measure (e.g., abusive head trauma clinical diagnosis), intervention type (e.g., education program), study methods, and results were summarized. Studies reporting on selected key methods elements essential for study comparison and public health decision making (e.g., economic perspective, time horizon, discounting, currency year) were assessed.

Evidence Synthesis: A total of 26 economic evaluation studies were assessed, most of which reported that assessed interventions yielded good value for money. Physical assault in the community and child abuse and neglect were the most common violence types examined. Studies applied a wide variety of cost estimates to value avoided violence. Less than two thirds of the studies reported all the key methods elements.

Conclusions: Comprehensive data collection on violence averted and intervention costs in experimental settings can increase opportunities to identify interventions that generate long-term value. More comprehensive estimates of the cost of violence can improve opportunities to demonstrate how prevention investment can be offset through avoided future costs. Better adherence to health economic evaluation reporting standards can enhance comparability across studies and may increase the likelihood that economic evidence is included in violence prevention decision making.
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http://dx.doi.org/10.1016/j.amepre.2020.11.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7987799PMC
April 2021

Systematic Review of Violence Prevention Economic Evaluations, 2000-2019.

Am J Prev Med 2021 04 16;60(4):552-562. Epub 2021 Feb 16.

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.

Context: Health economic evaluations (e.g., cost-effectiveness analysis) can guide the efficient use of resources to improve health outcomes. This study aims to summarize the content and quality of interpersonal violence prevention economic evaluations.

Evidence Acquisition: In 2020, peer-reviewed journal articles published during 2000-2019 focusing on high-income countries were identified using index terms in multiple databases. Study content, including violence type prevented (e.g., child abuse and neglect), outcome measure (e.g., abusive head trauma clinical diagnosis), intervention type (e.g., education program), study methods, and results were summarized. Studies reporting on selected key methods elements essential for study comparison and public health decision making (e.g., economic perspective, time horizon, discounting, currency year) were assessed.

Evidence Synthesis: A total of 26 economic evaluation studies were assessed, most of which reported that assessed interventions yielded good value for money. Physical assault in the community and child abuse and neglect were the most common violence types examined. Studies applied a wide variety of cost estimates to value avoided violence. Less than two thirds of the studies reported all the key methods elements.

Conclusions: Comprehensive data collection on violence averted and intervention costs in experimental settings can increase opportunities to identify interventions that generate long-term value. More comprehensive estimates of the cost of violence can improve opportunities to demonstrate how prevention investment can be offset through avoided future costs. Better adherence to health economic evaluation reporting standards can enhance comparability across studies and may increase the likelihood that economic evidence is included in violence prevention decision making.
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http://dx.doi.org/10.1016/j.amepre.2020.11.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7987799PMC
April 2021

Systematic review of unintentional injury prevention economic evaluations 2010-2019 and comparison to 1998-2009.

Accid Anal Prev 2020 Oct 9;146:105688. Epub 2020 Sep 9.

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, Atlanta, GA, 30341, United States.

Background: Health economic evaluation studies (e.g., cost-effectiveness analysis) can provide insight into which injury prevention interventions maximize available resources to improve health outcomes. A previous systematic review summarized 48 unintentional injury prevention economic evaluations published during 1998-2009, providing a valuable overview of that evidence for researchers and decisionmakers. The aim of this study was to summarize the content and quality of recent (2010-2019) economic evaluations of unintentional injury prevention interventions and compare to the previous publication period (1998-2009).

Methods: Peer-reviewed English-language journal articles describing public health unintentional injury prevention economic evaluations published January 1, 2010 to December 31, 2019 were identified using index terms in multiple databases. Injury causes, interventions, study methods, and results were summarized. Reporting on key methods elements (e.g., economic perspective, time horizon, discounting, currency year, etc.) was assessed. Reporting quality was compared between the recent and previous publication periods.

Results: Sixty-eight recent economic evaluation studies were assessed. Consistent with the systematic review on this topic for the previous publication period, falls and motor vehicle traffic injury prevention were the most common study subjects. Just half of studies from the recent publication period reported all key methods elements, although this represents an improvement compared to the previous publication period (25 %).

Conclusion: Most economic evaluations of unintentional injury prevention interventions address just two injury causes. Better adherence to health economic evaluation reporting standards may enhance comparability across studies and increase the likelihood that this type of evidence is included in decision-making related to unintentional injury prevention.
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http://dx.doi.org/10.1016/j.aap.2020.105688DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554223PMC
October 2020

Demographic considerations in analyzing decedents by usual occupation.

Am J Ind Med 2020 08 23;63(8):663-675. Epub 2020 May 23.

Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cinicinnati, Ohio.

Background: Public health research uses decedents' usual industry and occupation (I&O) from US death certificates to assess mortality incidence and risk factors. Of necessity, such research may exclude decedents with insufficient I&O information, and assume death certificates reflect current (at time of death) I&O. This study explored the demographic implications of such research conditions by describing usual occupation and current employment status among decedents by demographic characteristics in a large multistate data set.

Methods: Death certificate occupations classified by Standard Occupational Classification (SOC) (ie, compensated occupation) and other categories (eg, student) for 36 507 decedents (suicide, homicide, other, undetermined intent) age 22+ years from the 2016 National Violent Death Reporting System's (NVDRS) 32 US states were analyzed. Decedents not employed at the time of death (eg, laid off) were identified through nondeath certificate NVDRS data sources (eg, law enforcement reports).

Results: Female decedents, younger (age < 30 years) male decedents, some non-White racial group decedents, less educated decedents, and undetermined intent death decedents were statistically less likely to be classified by SOC based on death certificates-primarily due to insufficient information. Decedents classified by SOC from death certificates but whose non-death certificate data indicated no employment at the time of death were more often 30+ years old, White, less educated, died by suicide, or had nonmanagement occupations.

Conclusions: Whether decedents have classifiable occupations from death certificates may vary by demographic characteristics. Research studies that assess decedents by usual I&O can identify and describe how any such demographic trends may affect research results on particular public health topics.
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http://dx.doi.org/10.1002/ajim.23123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354205PMC
August 2020

Average lost work productivity due to non-fatal injuries by type in the USA.

Inj Prev 2021 Apr 4;27(2):111-117. Epub 2020 May 4.

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Objective: To estimate the average lost work productivity due to non-fatal injuries in the USA comprehensively by injury type.

Methods: The attributable average number and value of lost work days in the year following non-fatal emergency department (ED)-treated injuries were estimated by injury mechanism (eg, fall) and body region (eg, head and neck) among individuals age 18-64 with employer health insurance injured 1 October 2014 through 30 September 2015 as reported in MarketScan medical claims and Health and Productivity Management databases. Workplace, short-term disability and workers' compensation absences were assessed. Multivariable regression models compared lost work days among injury patients and matched controls during the year following injured patients' ED visit, controlling for demographic, clinical and health insurance factors. Lost work days were valued using an average US daily market production estimate. Costs are 2015 USD.

Results: The 1-year per-person average number and value of lost work days due to all types of non-fatal injuries combined were approximately 11 days and US$1590. The range by injury mechanism was 1.5 days (US$210) for bites and stings to 44.1 days (US$6196) for motorcycle injuries. The range by body region was 4.0 days (US$567) for other head, face and neck injuries to 19.8 days (US$2787) for traumatic brain injuries.

Conclusions And Relevance: Injuries are costly and preventable. Accurate estimates of attributable lost work productivity are important to monitor the economic burden of injuries and help to prioritise cost-effective public health prevention activities.
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http://dx.doi.org/10.1136/injuryprev-2019-043607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7609459PMC
April 2021

Average lost work productivity due to non-fatal injuries by type in the USA.

Inj Prev 2021 Apr 4;27(2):111-117. Epub 2020 May 4.

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Objective: To estimate the average lost work productivity due to non-fatal injuries in the USA comprehensively by injury type.

Methods: The attributable average number and value of lost work days in the year following non-fatal emergency department (ED)-treated injuries were estimated by injury mechanism (eg, fall) and body region (eg, head and neck) among individuals age 18-64 with employer health insurance injured 1 October 2014 through 30 September 2015 as reported in MarketScan medical claims and Health and Productivity Management databases. Workplace, short-term disability and workers' compensation absences were assessed. Multivariable regression models compared lost work days among injury patients and matched controls during the year following injured patients' ED visit, controlling for demographic, clinical and health insurance factors. Lost work days were valued using an average US daily market production estimate. Costs are 2015 USD.

Results: The 1-year per-person average number and value of lost work days due to all types of non-fatal injuries combined were approximately 11 days and US$1590. The range by injury mechanism was 1.5 days (US$210) for bites and stings to 44.1 days (US$6196) for motorcycle injuries. The range by body region was 4.0 days (US$567) for other head, face and neck injuries to 19.8 days (US$2787) for traumatic brain injuries.

Conclusions And Relevance: Injuries are costly and preventable. Accurate estimates of attributable lost work productivity are important to monitor the economic burden of injuries and help to prioritise cost-effective public health prevention activities.
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http://dx.doi.org/10.1136/injuryprev-2019-043607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7609459PMC
April 2021

Average medical cost of fatal and non-fatal injuries by type in the USA.

Inj Prev 2021 Feb 30;27(1):24-33. Epub 2019 Dec 30.

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Objective: To estimate the average medical care cost of fatal and non-fatal injuries in the USA comprehensively by injury type.

Methods: The attributable cost of injuries was estimated by mechanism (eg, fall), intent (eg, unintentional), body region (eg, head and neck) and nature of injury (eg, fracture) among patients injured from 1 October 2014 to 30 September 2015. The cost of fatal injuries was the multivariable regression-adjusted average among patients who died in hospital emergency departments (EDs) or inpatient settings as reported in the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample and National Inpatient Sample, controlling for demographic (eg, age), clinical (eg, comorbidities) and health insurance (eg, Medicaid) factors. The 1-year attributable cost of non-fatal injuries was assessed among patients with ED-treated injuries using MarketScan medical claims data. Multivariable regression models compared total medical payments (inpatient, outpatient, drugs) among non-fatal injury patients versus matched controls during the year following injury patients' ED visit, controlling for demographic, clinical and insurance factors. All costs are 2015 US dollars.

Results: The average medical cost of all fatal injuries was approximately $6880 and $41 570 per ED-based and hospital-based patient, respectively (range by injury type: $4764-$10 289 and $31 912-$95 295). The average attributable 1-year cost of all non-fatal injuries per person initially treated in an ED was approximately $6620 (range by injury type: $1698-$80 172).

Conclusions And Relevance: Injuries are costly and preventable. Accurate estimates of attributable medical care costs are important to monitor the economic burden of injuries and help to prioritise cost-effective public health prevention activities.
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http://dx.doi.org/10.1136/injuryprev-2019-043544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326639PMC
February 2021

Opioid-related US hospital discharges by type, 1993-2016.

J Subst Abuse Treat 2019 08 10;103:9-13. Epub 2019 May 10.

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.

Objective: To classify and compare US nationwide opioid-related hospital inpatient discharges over time by discharge type: 1) opioid use disorder (OUD) diagnosis without opioid overdose, detoxification, or rehabilitation services, 2) opioid overdose, 3) OUD diagnosis or opioid overdose with detoxification services, and 4) OUD diagnosis or opioid overdose with rehabilitation services.

Methods: Survey-weighted national analysis of hospital discharges in the Healthcare Cost and Utilization Project National Inpatient Sample yielded age-adjusted annual rates per 100,000 population. Annual percentage change (APC) in the rate of opioid-related discharges by type during 1993-2016 was assessed.

Results: The annual rate of hospital discharges documenting OUD without opioid overdose, detoxification, or rehabilitation services quadrupled during 1993-2016, and at an increased rate (8% annually) during 2003-2016. The discharge rate for all types of opioid overdose increased an average 5-9% annually during 1993-2010; discharges for non-heroin overdoses declined 2010-2016 (3-12% annually) while heroin overdose discharges increased sharply (23% annually). The rate of discharges including detoxification services among OUD and overdose patients declined (-4% annually) during 2008-2016 and rehabilitation services (e.g., counselling, pharmacotherapy) among those discharges decreased (-2% annually) during 1993-2016.

Conclusions: Over the past two decades, the rate of both OUD diagnoses and opioid overdoses increased substantially in US hospitals while rates of inpatient detoxification and rehabilitation services identified by diagnosis codes declined. It is critical that inpatients diagnosed with OUD or treated for opioid overdose are linked effectively to substance use disorder treatment at discharge.
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http://dx.doi.org/10.1016/j.jsat.2019.05.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592613PMC
August 2019

U.S. National 90-Day Readmissions After Opioid Overdose Discharge.

Am J Prev Med 2019 06 17;56(6):875-881. Epub 2019 Apr 17.

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.

Introduction: U.S. hospital discharges for opioid overdose increased substantially during the past two decades. This brief report describes 90-day readmissions among patients discharged from inpatient stays for opioid overdose.

Methods: In 2018, survey-weighted analysis of hospital stays in the 2016 Healthcare Cost and Utilization Project National Readmissions Database yielded the national estimated proportion of patients with opioid overdose stays that had all-cause readmissions within ≤90 days. A multivariable logistic regression model assessed index stay factors associated with readmission by type (opioid overdose or not). Number of readmissions per patient was assessed.

Results: More than 24% (n=14,351/58,850) of patients with non-fatal index stays for opioid overdose had at least one all-cause readmission ≤90 days of index stay discharge and 3% (n=1,658/58,850) of patients had at least one opioid overdose readmission. Less than 0.2% (n=104/58,850) of patients had more than one readmission for opioid overdose. Patient demographic characteristics (e.g., male, older age), comorbidities diagnosed during the index stay (e.g., drug use disorder, chronic pulmonary disease, psychoses), and other index stay factors (Medicare or Medicaid primary payer, discharge against medical advice) were significantly associated with both opioid overdose and non-opioid overdose readmissions. Nearly 30% of index stays for opioid overdose included heroin, which was significantly associated with opioid overdose readmissions.

Conclusions: A quarter of opioid overdose patients have ≤90 days all-cause readmissions, although opioid overdose readmission is uncommon. Effective strategies to reduce readmissions will address substance use disorder as well as comorbid physical and mental health conditions.
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http://dx.doi.org/10.1016/j.amepre.2018.12.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527476PMC
June 2019

A practical guide to episode groupers for cost-of-illness analysis in health services research.

SAGE Open Med 2019 29;7:2050312119840200. Epub 2019 Mar 29.

Bureau of Economic Analysis, Washington, DC, USA.

Despite the prominence of episode groupers for analysis and reimbursement in US payer settings, peer-reviewed articles using episode groupers for cost-of-illness analysis that informs public health research and decision-making are uncommon. This article provides a brief practical guide to episode-based cost analysis and offers some examples of episode grouper products. It is intended for an audience of health services researchers and managers in public health settings who perform or commission cost-of-illness studies with the US healthcare claims fee-for-service data but lack familiarity with episode groupers.
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http://dx.doi.org/10.1177/2050312119840200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6444409PMC
March 2019

Lifetime Number of Perpetrators and Victim-Offender Relationship Status Per U.S. Victim of Intimate Partner, Sexual Violence, or Stalking.

J Interpers Violence 2021 07 24;36(13-14):NP7284-NP7297. Epub 2019 Jan 24.

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.

The aim of this study was to describe the U.S. population-level prevalence of multiple perpetrator types (intimate partner, acquaintance, stranger, person of authority, or family member) per victim and to describe the prevalence of victim-offender relationship status combinations. Authors analyzed U.S. nationally representative data from noninstitutionalized adult respondents with self-reported lifetime exposure to intimate partner violence, sexual violence, or stalking in the 2012 National Intimate Partner and Sexual Violence Survey (NISVS). An estimated 142 million U.S. adults had some lifetime exposure to intimate partner violence, sexual violence, or stalking. An estimated 55 million victims (39% of total victims) had more than one perpetrator type during their lifetimes. A significantly higher proportion of female victims reported more than one perpetrator type compared with male victims (49% vs. 27%). Among both female and male victims with >1 perpetrator type, the most prevalent victim-offender relationship status combinations all included an intimate partner perpetrator. Many victims of interpersonal violence are subject to multiple perpetrator types during their lifetimes. Prevention strategies that address polyvictimization and protect victims from additional perpetrators can have a substantial and beneficial societal impact. Research on victim experiences to inform prevention strategies is strengthened by comprehensively accounting for lifetime victimizations.
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http://dx.doi.org/10.1177/0886260518824648DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6656628PMC
July 2021

Repeat Self-Inflicted Injury Among U.S. Youth in a Large Medical Claims Database.

Am J Prev Med 2019 03 15;56(3):411-419. Epub 2019 Jan 15.

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.

Introduction: This study describes characteristics of nonfatal self-inflicted injuries and incidence of repeat self-inflicted injuries among a large convenience sample of youth (aged 10-24 years) with Medicaid or commercial insurance.

Methods: In 2018, Truven Health MarketScan medical claims data were used to identify youth with a self-inflicted injury in 2013 (or index self-inflicted injury) diagnosed in any inpatient or outpatient setting. Patients with 2 years of healthcare claims data (1 year before/after index self-inflicted injury) were assessed. Patient and injury characteristics, repeat self-inflicted injuries ≤1 year, time to repeat self-inflicted injury, and number of emergency department and urgent care facility visits per patient are reported. A regression model assessed factors associated with repeat self-inflicted injuries.

Results: Among 4,681 self-inflicted injury patients, 70% were female. More than 71% of patients were treated for comorbidities (50% for depression) ≤1 year preceding the index self-inflicted injury. Poisoning was the most common index self-inflicted injury mechanism (60% of patients). Approximately 52% of patients had one or more emergency department visit and 1% had one or more urgent care facility visit, respectively, during the 2-year observation period. More than 11% of patients repeated self-inflicted injury ≤1 year (and 3% ≤7 days). Repeat self-inflicted injury was associated with younger patient age, being female, a self-inflicted injury event preceding the index self-inflicted injury, index self-inflicted injury treatment setting, and patient comorbidities.

Conclusions: Approximately one in ten youth repeated self-inflicted injury within 1 year and nearly half of youth with clinically treated self-inflicted injuries never received care in hospitals or emergency departments. Physicians and families should be aware of risk factors for repeat self-inflicted injury, including mental health comorbidities. Multilevel strategies are needed to prevent youth self-inflicted injuries.
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http://dx.doi.org/10.1016/j.amepre.2018.09.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380925PMC
March 2019

Repeat Self-Inflicted Injury Among U.S. Youth in a Large Medical Claims Database.

Am J Prev Med 2019 03 15;56(3):411-419. Epub 2019 Jan 15.

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.

Introduction: This study describes characteristics of nonfatal self-inflicted injuries and incidence of repeat self-inflicted injuries among a large convenience sample of youth (aged 10-24 years) with Medicaid or commercial insurance.

Methods: In 2018, Truven Health MarketScan medical claims data were used to identify youth with a self-inflicted injury in 2013 (or index self-inflicted injury) diagnosed in any inpatient or outpatient setting. Patients with 2 years of healthcare claims data (1 year before/after index self-inflicted injury) were assessed. Patient and injury characteristics, repeat self-inflicted injuries ≤1 year, time to repeat self-inflicted injury, and number of emergency department and urgent care facility visits per patient are reported. A regression model assessed factors associated with repeat self-inflicted injuries.

Results: Among 4,681 self-inflicted injury patients, 70% were female. More than 71% of patients were treated for comorbidities (50% for depression) ≤1 year preceding the index self-inflicted injury. Poisoning was the most common index self-inflicted injury mechanism (60% of patients). Approximately 52% of patients had one or more emergency department visit and 1% had one or more urgent care facility visit, respectively, during the 2-year observation period. More than 11% of patients repeated self-inflicted injury ≤1 year (and 3% ≤7 days). Repeat self-inflicted injury was associated with younger patient age, being female, a self-inflicted injury event preceding the index self-inflicted injury, index self-inflicted injury treatment setting, and patient comorbidities.

Conclusions: Approximately one in ten youth repeated self-inflicted injury within 1 year and nearly half of youth with clinically treated self-inflicted injuries never received care in hospitals or emergency departments. Physicians and families should be aware of risk factors for repeat self-inflicted injury, including mental health comorbidities. Multilevel strategies are needed to prevent youth self-inflicted injuries.
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http://dx.doi.org/10.1016/j.amepre.2018.09.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380925PMC
March 2019

Non-fatal self-inflicted versus undetermined intent injuries: patient characteristics and incidence of subsequent self-inflicted injuries.

Inj Prev 2019 12 23;25(6):521-528. Epub 2018 Oct 23.

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.

Background: Non-fatal self-inflicted (SI) injuries may be underidentified in administrative medical data sources.

Objective: Compare patients with SI versus undetermined intent (UI) injuries according to patient characteristics, incidence of subsequent SI injury and risk factors for subsequent SI injury.

Methods: Truven Health MarketScan was used to identify patients' (aged 10-64) first SI or UI injury in 2015 (index injury). Patient characteristics and subsequent SI within 1 year were assessed. A logistic regression model examined factors associated with subsequent SI.

Results: Among analysed patients (n=44 806; 36% SI, 64% UI), a higher proportion of patients with SI index injury were female, had preceding comorbidities (eg, depression), Medicaid (vs commercial insurance), treatment in an ambulance or hospital and cut/pierce or poisoning injuries compared with patients with UI index injury. Just 1% of patients with UI had subsequent SI≤1 year vs 16% of patients with SI. Among patients with UI index injury, incidence of and risk factors for subsequent SI injury were similar across assessed age groups (10-24 years, 25-44 years, 45-64 years). Severe injuries (eg, treated in emergency department), cut/pierce or poisoning injuries, mental health and substance use disorder comorbidities and Medicaid (among adult patients) were risk factors for subsequent SI among patients with UI index injuries.

Conclusions: Regardless of circumstances that influence clinicians' SI vs UI coding decisions, information on incidence of and risk factors for subsequent SI can help to inform clinical treatment decisions when SI injury is suspected as well as provide evidence to support the development and implementation of self-harm prevention activities.
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http://dx.doi.org/10.1136/injuryprev-2018-042933DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478558PMC
December 2019

The economic burden of child maltreatment in the United States, 2015.

Child Abuse Negl 2018 12 8;86:178-183. Epub 2018 Oct 8.

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.

Child maltreatment incurs a high lifetime cost per victim and creates a substantial US population economic burden. This study aimed to use the most recent data and recommended methods to update previous (2008) estimates of 1) the per-victim lifetime cost, and 2) the annual US population economic burden of child maltreatment. Three ways to update the previous estimates were identified: 1) apply value per statistical life methodology to value child maltreatment mortality, 2) apply monetized quality-adjusted life years methodology to value child maltreatment morbidity, and 3) apply updated estimates of the exposed population. As with the previous estimates, the updated estimates used the societal cost perspective and lifetime horizon, but also accounted for victim and community intangible costs. Updated methods increased the estimated nonfatal child maltreatment per-victim lifetime cost from $210,012 (2010 USD) to $830,928 (2015 USD) and increased the fatal per-victim cost from $1.3 to $16.6 million. The estimated US population economic burden of child maltreatment based on 2015 substantiated incident cases (482,000 nonfatal and 1670 fatal victims) was $428 billion, representing lifetime costs incurred annually. Using estimated incidence of investigated annual incident cases (2,368,000 nonfatal and 1670 fatal victims), the estimated economic burden was $2 trillion. Accounting for victim and community intangible costs increased the estimated cost of child maltreatment considerably compared to previous estimates. The economic burden of child maltreatment is substantial and might off-set the cost of evidence-based interventions that reduce child maltreatment incidence.
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http://dx.doi.org/10.1016/j.chiabu.2018.09.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289633PMC
December 2018

Lifetime Economic Burden of Intimate Partner Violence Among U.S. Adults.

Am J Prev Med 2018 10 22;55(4):433-444. Epub 2018 Aug 22.

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.

Introduction: This study estimated the U.S. lifetime per-victim cost and economic burden of intimate partner violence.

Methods: Data from previous studies were combined with 2012 U.S. National Intimate Partner and Sexual Violence Survey data in a mathematical model. Intimate partner violence was defined as contact sexual violence, physical violence, or stalking victimization with related impact (e.g., missed work days). Costs included attributable impaired health, lost productivity, and criminal justice costs from the societal perspective. Mean age at first victimization was assessed as 25 years. Future costs were discounted by 3%. The main outcome measures were the mean per-victim (female and male) and total population (or economic burden) lifetime cost of intimate partner violence. Secondary outcome measures were marginal outcome probabilities among victims (e.g., anxiety disorder) and associated costs. Analysis was conducted in 2017.

Results: The estimated intimate partner violence lifetime cost was $103,767 per female victim and $23,414 per male victim, or a population economic burden of nearly $3.6 trillion (2014 US$) over victims' lifetimes, based on 43 million U.S. adults with victimization history. This estimate included $2.1 trillion (59% of total) in medical costs, $1.3 trillion (37%) in lost productivity among victims and perpetrators, $73 billion (2%) in criminal justice activities, and $62 billion (2%) in other costs, including victim property loss or damage. Government sources pay an estimated $1.3 trillion (37%) of the lifetime economic burden.

Conclusions: Preventing intimate partner violence is possible and could avoid substantial costs. These findings can inform the potential benefit of prioritizing prevention, as well as evaluation of implemented prevention strategies.
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http://dx.doi.org/10.1016/j.amepre.2018.04.049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6161830PMC
October 2018

US hospital discharges documenting patient opioid use disorder without opioid overdose or treatment services, 2011-2015.

J Subst Abuse Treat 2018 09 20;92:35-39. Epub 2018 Jun 20.

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.

Background: Understanding more about circumstances in which patients receive an opioid use disorder (OUD) diagnosis might illuminate opportunities for intervention and ultimately prevent opioid overdoses. This study aimed to describe patient and clinical characteristics of hospital discharges documenting OUD among patients not being treated for opioid overdose, detoxification, or rehabilitation.

Methods: We assessed patient, payer, and clinical characteristics of nationally-representative 2011-2015 National Inpatient Sample discharges documenting OUD, excluding opioid overdose, detoxification, and rehabilitation. Discharges were clinically classified by Diagnostic Related Group (DRG) for analysis.

Results: Annual discharges grew 38%, from 347,137 (2011) to 478,260 (2015), totaling 2 million discharges during the study period. The annual discharge rate increased among all racial/ethnic groups, but was highest among the non-Hispanic black population until 2015, when non-Hispanic whites had a slightly higher rate (164 versus 162 per 100,000 population). Female patients and Medicaid and Medicare as primary payer accounted for an increasing annual proportion of discharges. Just 14 DRGs accounted for nearly 50% of discharges over the study period. The most prevalent primary treatment received during OUD inpatient stays was for psychoses (DRG 885; 16% of discharges) and drug and alcohol abuse or dependence symptoms (including withdrawal) or (non-opioid) poisoning (DRG 894, 897, 917, 918; 12% of discharges).

Conclusions: Now nearly half a million yearly US hospital discharges for a range of primary treatment include patients' diagnosis of OUD without opioid overdose, detoxification, or rehabilitation services. Inpatient stays present an important opportunity to link OUD patients to treatment to reduce opioid-related morbidity and mortality.
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http://dx.doi.org/10.1016/j.jsat.2018.06.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6084454PMC
September 2018

Short-term Lost Productivity per Victim: Intimate Partner Violence, Sexual Violence, or Stalking.

Am J Prev Med 2018 07 18;55(1):106-110. Epub 2018 Jun 18.

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.

Introduction: The purpose of this study is to estimate victims' lifetime short-term lost productivity because of intimate partner violence, sexual violence, or stalking.

Methods: U.S. nationally representative data from the 2012 National Intimate Partner and Sexual Violence Survey were used to estimate a regression-adjusted average per victim (female and male) and total population number of cumulative short-term lost work and school days (or lost productivity) because of victimizations over victims' lifetimes. Victims' lost productivity was valued using a U.S. daily production estimate. Analysis was conducted in 2017.

Results: Non-institutionalized adults with some lifetime exposure to intimate partner violence, sexual violence, or stalking (n=6,718 respondents; survey-weighted n=130,795,789) reported nearly 741 million lost productive days because of victimizations by an average of 2.5 perpetrators per victim. The adjusted per victim average was 4.9 (95% CI=3.9, 5.9) days, controlling for victim, perpetrator, and violence type factors. The estimated societal cost of this short-term lost productivity was $730 per victim, or $110 billion across the lifetimes of all victims (2016 USD). Factors associated with victims having a higher number of lost days included a higher number of perpetrators and being female, as well as sexual violence, physical violence, or stalking victimization by an intimate partner perpetrator, stalking victimization by an acquaintance perpetrator, and sexual violence or stalking victimization by a family member perpetrator.

Conclusions: Short-term lost productivity represents a minimum economic valuation of the immediate negative effects of intimate partner violence, sexual violence, and stalking. Victims' lost productivity affects family members, colleagues, and employers.
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http://dx.doi.org/10.1016/j.amepre.2018.03.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6014928PMC
July 2018

US campus fraternities and sororities and the young adult injury burden.

J Am Coll Health 2018 07 12;66(5):340-349. Epub 2018 Mar 12.

a National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC) , Atlanta , Georgia , USA.

Objective: To investigate whether the presence of fraternities and sororities was associated with a higher local injury rate among undergraduate-age youth.

Methods: In 2016 we compared the rate of 2010-2013 youth (18-24 years) emergency department (ED) visits for injuries in Hospital Service Areas (HSA) with and without fraternities and sororities. ED visits were identified in the State Emergency Department Database (n=1,560 hospitals, 1,080 HSAs, 16 states). US Census Bureau and National Center for Education Statistics sources identified HSA population and campus (n=659) characteristics. A proprietary database identified campuses with fraternities and sororities (n=287). ED visits explicitly linked to fraternities and sororities in the National Electronic Injury Surveillance System-All Injury Program were used to identify injury causes for sub-group analysis.

Results: HSAs serving campuses with fraternities and sororities had lower age 18-24 injury rates for all causes except firearm injuries (no difference).

Conclusions: Fraternities and sororities were not associated with a higher injury rate at the population level among undergraduate-age youth. A major limitation is not being able to observe campus health services utilization.
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http://dx.doi.org/10.1080/07448481.2018.1431899DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6002919PMC
July 2018

Cost and Cost-Effectiveness Assessments of Newborn Screening for Critical Congenital Heart Disease Using Pulse Oximetry: A Review.

Int J Neonatal Screen 2017 14;3(4):34. Epub 2017 Dec 14.

Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, 4770 Buford Highway NE, Mail Stop E-87, Atlanta, GA 30341, USA.

Screening newborns for critical congenital heart disease (CCHD) using pulse oximetry is recommended to allow for the prompt diagnosis and prevention of life-threatening crises. The present review summarizes and critiques six previously published estimates of the costs or cost-effectiveness of CCHD screening from the United Kingdom, United States, and China. Several elements that affect CCHD screening costs were assessed in varying numbers of studies, including screening staff time, instrumentation, and consumables, as well as costs of diagnosis and treatment. A previous US study that used conservative assumptions suggested that CCHD screening is likely to be considered cost-effective from the healthcare sector perspective. Newly available estimates of avoided infant CCHD deaths in several US states that implemented mandatory CCHD screening policies during 2011-2013 suggest a substantially larger reduction in deaths than was projected in the previous US cost-effectiveness analysis. Taking into account these new estimates, we estimate that cost per life-year gained could be as low as USD 12,000. However, that estimate does not take into account future costs of health care and education for surviving children with CCHD nor the costs incurred by health departments to support and monitor CCHD screening policies and programs.
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http://dx.doi.org/10.3390/ijns3040034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5784211PMC
December 2017

Cost-Benefit Analysis of Two Child Abuse and Neglect Primary Prevention Programs for US States.

Prev Sci 2018 08;19(6):705-715

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Mailstop F-62, 4770 Buford Highway, Atlanta, GA, 30341, USA.

We assessed the US state-level budget and societal impact of implementing two child abuse and neglect (CAN) primary prevention programs. CAN cost estimates and data from two prevention programs (Child-Parent Centers and Nurse-Family Partnership) were combined with current population, cost, and CAN incidence data by US state. A cost-benefit mathematical model for each program by US state compared program costs with the future monetary value of benefits from reduced CAN. The models used a lifetime time horizon from government payer and societal perspectives. Both programs could potentially avert CAN among tens of thousands of children across the country. Lower costs from reduced CAN may substantially offset, but not always entirely eliminate, payers' program implementation cost. Results are sensitive to the rate of CAN in each US state. Given the considerable lifetime societal cost of CAN, including victims' lost work productivity, the programs were cost saving from the societal perspective in all US states using base case methods. This analysis represents an overall minimum return on payers' investment because averted CAN is just one of many positive health and educational outcomes associated with these programs and non-monetary benefits from reduced CAN were not included. Translating cost and effectiveness research on injury prevention programs for local conditions might increase decision makers' adoption of effective programs.
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http://dx.doi.org/10.1007/s11121-017-0819-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5777909PMC
August 2018

Lifetime Cost of Abusive Head Trauma at Ages 0-4, USA.

Prev Sci 2018 08;19(6):695-704

Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada.

This paper aims to estimate lifetime costs resulting from abusive head trauma (AHT) in the USA and the break-even effectiveness for prevention. A mathematical model incorporated data from Vital Statistics, the Healthcare Cost and Utilization Project Kids' Inpatient Database, and previous studies. Unit costs were derived from published sources. From society's perspective, discounted lifetime cost of an AHT averages $5.7 million (95% CI $3.2-9.2 million) for a death. It averages $2.6 million (95% CI $1.0-2.9 million) for a surviving AHT victim including $224,500 for medical care and related direct costs (2010 USD). The estimated 4824 incident AHT cases in 2010 had an estimated lifetime cost of $13.5 billion (95% CI $5.5-16.2 billion) including $257 million for medical care, $552 million for special education, $322 million for child protective services/criminal justice, $2.0 billion for lost work, and $10.3 billion for lost quality of life. Government sources paid an estimated $1.3 billion. Out-of-pocket benefits of existing prevention programming would exceed its costs if it prevents 2% of cases. When a child survives AHT, providers and caregivers can anticipate a lifetime of potentially costly and life-threatening care needs. Better effectiveness estimates are needed for both broad prevention messaging and intensive prevention targeting high-risk caregivers.
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http://dx.doi.org/10.1007/s11121-017-0815-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756522PMC
August 2018

Injury Deaths Among U.S. Females: CDC Resources and Programs.

J Womens Health (Larchmt) 2017 04 15;26(4):307-312. Epub 2017 Mar 15.

1 Division of Analysis, Research, and Practice Integration, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia .

Injury death rates are lower for women than for men at all ages, but we have a long way to go in understanding the circumstances of injury fatalities among females. This article presents resources that can be used to examine the most recent data on injury fatalities among females and highlights activities of CDC's Injury Center. The National Center for Injury Prevention and Control's (NCIPC's) Web-based Injury Statistics Query and Reporting System, an online surveillance database, can be used to examine injury deaths. We present examples that show the 2015 number of female fatal injuries by age group and injury cause and method, as well as a 2008-2014 county-level map of female fatal injury rates. In 2015, there were 68,572 injury fatalities of females of age ≥1 year, equivalent to 1 death every 7 minutes. Injuries were the leading cause of death for females of ages 1-41 years and the sixth-ranked cause of female death overall. Falls were the leading cause of injury death overall (and for women ≥70 years), unintentional poisonings were second, and motor vehicle traffic injuries were third. NCIPC funds national organizations, state health agencies, and other groups to develop, implement, and promote effective injury and violence prevention and control practices. Five key programs are discussed. Presenting data on injury fatalities is an essential element in identifying meaningful prevention efforts. Further investigation of the causes and impact of female injury fatalities can refine the public health approach to reduce this injury burden.
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http://dx.doi.org/10.1089/jwh.2017.6348DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683079PMC
April 2017

Preventing deaths and injuries from house fires: a cost-benefit analysis of a community-based smoke alarm installation programme.

Inj Prev 2018 02 9;24(1):12-18. Epub 2017 Feb 9.

Injury Prevention Center of Greater Dallas, Dallas, Texas, USA.

Background: Operation Installation (OI), a community-based smoke alarm installation programme in Dallas, Texas, targets houses in high-risk urban census tracts. Residents of houses that received OI installation (or programme houses) had 68% fewer medically treated house fire injuries (non-fatal and fatal) compared with residents of non-programme houses over an average of 5.2 years of follow-up during an effectiveness evaluation conducted from 2001 to 2011.

Objective: To estimate the cost-benefit of OI.

Methods: A mathematical model incorporated programme cost and effectiveness data as directly observed in OI. The estimated cost per smoke alarm installed was based on a retrospective analysis of OI expenditures from administrative records, 2006-2011. Injury incidence assumptions for a population that had the OI programme compared with the same population without the OI programme was based on the previous OI effectiveness study, 2001-2011. Unit costs for medical care and lost productivity associated with fire injuries were from a national public database.

Results: From a combined payers' perspective limited to direct programme and medical costs, the estimated incremental cost per fire injury averted through the OI installation programme was $128,800 (2013 US$). When a conservative estimate of lost productivity among victims was included, the incremental cost per fire injury averted was negative, suggesting long-term cost savings from the programme. The OI programme from 2001 to 2011 resulted in an estimated net savings of $3.8 million, or a $3.21 return on investment for every dollar spent on the programme using a societal cost perspective.

Conclusions: Community smoke alarm installation programmes could be cost-beneficial in high-fire-risk neighbourhoods.
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http://dx.doi.org/10.1136/injuryprev-2016-042247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5550354PMC
February 2018

Lifetime Economic Burden of Rape Among U.S. Adults.

Am J Prev Med 2017 Jun 30;52(6):691-701. Epub 2017 Jan 30.

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.

Introduction: This study estimated the per-victim U.S. lifetime cost of rape.

Methods: Data from previous studies was combined with current administrative data and 2011 U.S. National Intimate Partner and Sexual Violence Survey data in a mathematical model. Rape was defined as any lifetime completed or attempted forced penetration or alcohol- or drug-facilitated penetration, measured among adults not currently institutionalized. Costs included attributable impaired health, lost productivity, and criminal justice costs from the societal perspective. Average age at first rape was assumed to be 18 years. Future costs were discounted by 3%. The main outcome measures were the average per-victim (female and male) and total population discounted lifetime cost of rape. Secondary outcome measures were marginal outcome probabilities among victims (e.g., suicide attempt) and perpetrators (e.g., incarceration) and associated costs. Analysis was conducted in 2016.

Results: The estimated lifetime cost of rape was $122,461 per victim, or a population economic burden of nearly $3.1 trillion (2014 U.S. dollars) over victims' lifetimes, based on data indicating >25 million U.S. adults have been raped. This estimate included $1.2 trillion (39% of total) in medical costs; $1.6 trillion (52%) in lost work productivity among victims and perpetrators; $234 billion (8%) in criminal justice activities; and $36 billion (1%) in other costs, including victim property loss or damage. Government sources pay an estimated $1 trillion (32%) of the lifetime economic burden.

Conclusions: Preventing sexual violence could avoid substantial costs for victims, perpetrators, healthcare payers, employers, and government payers. These findings can inform evaluations of interventions to reduce sexual violence.
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http://dx.doi.org/10.1016/j.amepre.2016.11.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5438753PMC
June 2017

A data-driven allocation tool for in-kind resources distributed by a state health department.

Traffic Inj Prev 2016 10 18;17(7):681-5. Epub 2016 Feb 18.

a National Center for Injury Prevention and Control, Centers for Disease Control and Prevention , Atlanta , Georgia.

Objective: The objective of this study was to leverage a state health department's operational data to allocate in-kind resources (children's car seats) to counties, with the proposition that need-based allocation could ultimately improve public health outcomes.

Methods: This study used a retrospective analysis of administrative data on car seats distributed to counties statewide by the Georgia Department of Public Health and development of a need-based allocation tool (presented as interactive supplemental digital content, adaptable to other types of in-kind public health resources) that relies on current county-level injury and sociodemographic data.

Results: Car seat allocation using public health data and a need-based formula resulted in substantially different recommended allocations to individual counties compared to historic distribution.

Conclusions: Results indicate that making an in-kind public health resource like car seats universally available results in a less equitable distribution of that resource compared to deliberate allocation according to public health need. Public health agencies can use local data to allocate in-kind resources consistent with health objectives; that is, in a manner offering the greatest potential health impact. Future analysis can determine whether the change to a more equitable allocation of resources is also more efficient, resulting in measurably improved public health outcomes.
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http://dx.doi.org/10.1080/15389588.2016.1142079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5024329PMC
October 2016

Paid family leave's effect on hospital admissions for pediatric abusive head trauma.

Inj Prev 2016 12 11;22(6):442-445. Epub 2016 Feb 11.

National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.

Paediatric abusive head trauma (AHT) is a leading cause of fatal child maltreatment among young children. Current prevention efforts have not been consistently effective. Policies such as paid parental leave could potentially prevent AHT, given its impacts on risk factors for child maltreatment. To explore associations between California's 2004 paid family leave (PFL) policy and hospital admissions for AHT, we used difference-in-difference analyses of 1995-2011 US state-level data before and after the policy in California and seven comparison states. Compared with seven states with no PFL policies, California's 2004 PFL showed a significant decrease in AHT admissions in both <1 and <2-year-olds. Analyses using additional data years and comparators could yield different results.
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http://dx.doi.org/10.1136/injuryprev-2015-041702DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4981551PMC
December 2016

Professional Fee Ratios for US Hospital Discharge Data.

Med Care 2015 Oct;53(10):840-9

*National Center for Injury Prevention and Control †National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.

Background: US hospital discharge datasets typically report facility charges (ie, room and board), excluding professional fees (ie, attending physicians' charges).

Objectives: We aimed to estimate professional fee ratios (PFR) by year and clinical diagnosis for use in cost analyses based on hospital discharge data.

Subjects: The subjects consisted of a retrospective cohort of Truven Health MarketScan 2004-2012 inpatient admissions (n=23,594,605) and treat-and-release emergency department (ED) visits (n=70,771,576).

Measures: PFR per visit was assessed as total payments divided by facility-only payments.

Research Design: Using ordinary least squares regression models controlling for selected characteristics (ie, patient age, comorbidities, etc.), we calculated adjusted mean PFR for admissions by health insurance type (commercial or Medicaid) per year overall and by Major Diagnostic Category (MDC), Diagnostic Related Group, Healthcare Cost and Utilization Project Clinical Classification Software, and primary International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) diagnosis, and for ED visits per year overall and by MDC and primary ICD-9-CM diagnosis.

Results: Adjusted mean PFR for 2012 admissions, including preceding ED visits, was 1.264 (95% CI, 1.264, 1.265) for commercially insured admissions (n=2,614,326) and 1.177 (1.176, 1.177) for Medicaid admissions (n=816,503), indicating professional payments increased total per-admission payments by an average 26.4% and 17.7%, respectively, above facility-only payments. Adjusted mean PFR for 2012 ED visits was 1.286 (1.286, 1.286) for commercially insured visits (n=8,808,734) and 1.440 (1.439, 1.440) for Medicaid visits (n=2,994,696). Supplemental tables report 2004-2012 annual PFR estimates by clinical classifications.

Conclusions: Adjustments for professional fees are recommended when hospital facility-only financial data from US hospital discharge datasets are used to estimate health care costs.
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http://dx.doi.org/10.1097/MLR.0000000000000410DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4681390PMC
October 2015
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