title: High-risk behavior and the public burden for funding the costs of acute injury.
abstract: OBJECTIVE
  To determine if high-risk behavior is associated with increased injury severity and cost and if public agencies bear a disproportionate burden of that cost.
  
  
  METHODS
  Case comparison study utilizing patient data collected over a 10-year period.
  
  
  METHODS
  Five level 1 and 2 trauma centers in an urban-suburban community with a population of 2.4 million.
  
  
  METHODS
  Trauma registry data from 37,304 consecutive hospitalized adult patients with trauma. Financial data were reported and analyzed on 28,842 of these.
  
  
  METHODS
  Incidence of alcohol intoxication, other drug use, use of vehicular protective devices, and firearm violence injuries in patients with private vs public health care sponsorship. Length of hospital stay, injury severity, and hospital unit charges were assessed for high-risk behavior.
  
  
  RESULTS
  High-risk behavior was more prevalent among trauma patients relying on public funding to cover the costs of their injuries (P < .001). Total hospital unit charges were 28% and 35% higher for motorists not wearing seat belts and motorcyclists not wearing helmets, respectively. Injury severity and length of stay were also higher (P < .001).
  
  
  CONCLUSIONS
  High-risk behavior is associated with increased injury severity and cost. Trauma victims exhibiting high-risk behavior more often depend on public agencies to cover the cost of acute injury. Failure to establish and enforce laws and policies designed to reduce or prevent injury may generate enormous trauma care costs, borne to a large extent by public agencies. Further restriction of certain types of high-risk behavior and the institution of "users' fees," taxes, or penalties may be necessary to reduce the disproportionate public agency cost generated by this activity.
authors.affiliation: Department of Surgery, University of California, San Francisco, USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Mackersie
authors.forename: J W
authors.initials: JW
authors.lastname: Davis
authors.forename: D B
authors.initials: DB
authors.lastname: Hoyt
authors.forename: T
authors.initials: T
authors.lastname: Holbrook
authors.forename: S R
authors.initials: SR
authors.lastname: Shackford
mesh_terms: D000208:Acute Disease; D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects; D002140:California; D005260:Female; D005380:Financing, Government / Q000191:economics*; D006260:Head Protective Devices / Q000706:statistics & numerical data; D017722:Hospital Charges; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000191:economics; D008297:Male; D012042:Registries; D012309:Risk-Taking; D012622:Seat Belts / Q000706:statistics & numerical data; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000191:economics*