title: Trends and burden of firearm-related hospitalizations in the United States across 2001-2011.
abstract: BACKGROUND
  Firearm-related hospitalizations are a major burden to the current health care infrastructure. We examined the trends in the incidence and case-fatality rates of firearm-related hospitalizations over the past decade. We also hypothesized that major national economic perturbations would be partly responsible and correlate temporally with national firearm-related hospitalization trends.
  
  
  METHODS
  We used the 2001-2011 Nationwide Inpatient Sample for analysis. Firearm-related hospitalizations were identified using International Classification of Diseases, 9(th) Revision codes. In addition, we examined the relationship between the US stock market performance (Dow Jones Industrial Average) and the annual firearm-related hospitalization incidence rates.
  
  
  RESULTS
  In the last decade, there has been a modest decline in firearm-related hospitalizations, interrupted by spikes in the annual incidence that closely corresponded to periods of national economic instability. In addition, the overall case-fatality rate following firearm-related hospitalization has been stable at ∼8%; the highest rates being present among those who attempted suicide using firearms. Also, there has been an increase in the prevalence of mental health disorders among individuals admitted with firearm-related injuries. Moreover, there was an increase in the length of stay and the cost/charges associated with hospitalization over the last decade.
  
  
  CONCLUSIONS
  Over 2001-2011, the national incidence of firearm-related hospitalizations has closely tracked the national stock market performance, suggesting that economic perturbations and resultant insecurities might underlie the perpetuation of firearm-related injuries. Although the case-fatality rates have remained stable, the length of stay and hospitalization costs have increased, imposing additional burden on existing health care resources.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Ohio. Electronic address: dr.shikhar.agarwal@gmail.com.
authors.forename: Shikhar
authors.initials: S
authors.lastname: Agarwal
mesh_terms: D017281:Cost of Illness; D057172:Economic Recession; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014948:Wounds, Gunshot / Q000191:economics / Q000453:epidemiology*
keywords: Case fatality; Cost of illness; Firearms; In-hospital mortality; Length of stay