• Gozienna Okeke, Mahrukh Sana, Erfan Faridmoayer, Panos Kougias, and Sherene E Sharath.
• Harpur College of Arts and Sciences, State University of New York Binghamton University, Binghamton, New York.
• Am J Prev Med. 2025 Jan 1; 68 (1): 758275-82.

IntroductionFirearm-related injuries (FRIs) are serious but a preventable public health issue. The objective of this study was to describe FRI inpatient costs by (1) patient insurance payer type and (2) hospital safety-net mix.MethodsFRIs were identified using International Classification of Disease diagnosis codes in the National Inpatient Sample. All admissions between 2003 and 2020 were included. The primary outcome was consumer-price index adjusted inpatient stay costs. Mixed effects generalized linear regressions, with a random intercept at the hospital level, were used to describe costs. Analyses were sample weighted and performed between 2023 and 2024.ResultsAmong 538,795 FRIs, the median age was 27 years (interquartile range: 21-37 years). Injuries by payer type were highest among self-pay (280,161; 39%), followed by Medicaid (182,716; 34%), private (113,650; 21%), and Medicare (30,110; 6%). Inflation-adjusted costs of FRI stays totaled $15.2 billion, with $6.2 billion from Medicaid and $5 billion from the self-pay group. After 2014, FRI incidence declined among self-pay/no-charge patients and increased among Medicaid-covered patients-representing a 127% total increase in Medicaid costs from $169 million in 2003 to $753 million in 2020. Among moderate-high and high safety-net mix hospitals, costs increased from $257 million in 2003 to $567 million in 2020.ConclusionsThe incidence and costs of FRIs among Medicaid-insured has substantially increased since 2003. Importantly, these increased costs are disproportionately placed on disadvantaged patients and safety-net hospitals.Published by Elsevier Inc.

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