Economics of Injury and Violence Prevention

Cost of fatal and nonfatal injury

Unintentional and violence-related injuries cause more than 300,000 deaths among people of all ages in the United States each year. Unintentional injuries are the leading cause of death for people ages 1-44.

About 21 million people are treated and released from emergency departments with nonfatal injuries each year. Nonfatal injuries can cause life-long mental, physical, and financial problems.

Fatal and nonfatal injuries are costly. The 2019 cost of injury in the United States was $4.2 trillion, according to a report in CDC's MMWR. The costs include spending on healthcare, lost work productivity, as well as estimates of cost for lost quality of life and lives lost.

A CDC study estimated the medical care and lost work cost due to fatal and nonfatal injuries in the US.

• The average medical cost of fatal injuries was approximately $45,678 per hospitalized patient and $4,777 per emergency department patient.
• The average cost of nonfatal injuries per person initially treated in an emergency department was approximately $5,800 in related medical spending and $1,690 in work loss over one year. These costs were higher for those who needed inpatient care, with $52,250 in medical expenses and $7,820 in lost work.

Keeping track of the current average cost of injuries and violence per person is important to understand the economic burden of injuries and evaluate the benefits of prevention efforts.

State-level cost of fatal injuries

According to the cost of fatal injuries for states report, the states with the highest per capita 2019 cost of fatal injuries were West Virginia, New Mexico, Alaska, and Louisiana. The states with the lowest fatal injury costs were New York, California, Minnesota, Nebraska, and Texas. All states face substantial avoidable costs due to injury deaths.

Cost of opioid overdose and use disorder

Fatal opioid overdoses and opioid use disorder cost the United States $1.02 trillion in 2017. The most complete accounting to date of America's opioid crisis was released by CDC in the journal Drug and Alcohol Dependence. The study computed costs for spending on healthcare, opioid use disorder treatment, criminal justice, and lost work productivity. It also estimated the costs for lost quality of life and lives lost.

This CDC study expands and updates two prior estimates of the cost of the opioid crisis: a 2016 CDC economic cost study and a 2017 report released by the White House Council of Economic Advisors. In 2017, more than 2.1 million people over age 12 had an opioid use disorder, and over 47,000 opioid overdose deaths occurred.

Key findings include:

• The value of life lost due to overdose deaths was $480.7 billion.
• Opioid use disorder accounted for $471.0 billion.
• Almost $35 billion was spent on healthcare and opioid use disorder treatment.
  • Healthcare costs were $31.3 billion.
  • Opioid use disorder treatment was $3.5 billion.
• Criminal justice spending accounted for $14.8 billion.

Cost of nonfatal traumatic brain injury

Traumatic brain injury (TBI) is a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury. Everyone is at risk for a TBI. TBIs substantially contribute to healthcare costs each year. A CDC study in the journal Medical Care estimated the annual healthcare cost of nonfatal TBIs by severity level among children and adults in 2016 during the year following a TBI diagnosis.

Key findings include:

• The total annual healthcare cost of nonfatal TBIs was over $40.6 billion.
• Healthcare costs include $10.1 billion by private insurance, $22.5 billion by Medicare, and $8 billion by Medicaid.
• More than 2 million nonfatal injuries were related to TBI.

A CDC study estimated the medical and work loss costs of TBI per injury person in the U.S. and found that

• The average medical cost of fatal TBI injuries was approximately $47,952 per hospitalized patient and $5,052 per emergency department patient.
• The average cost of nonfatal TBI injuries per person initially treated in an emergency department was approximately $4,530 in related medical spending and $1,500 in work loss over one year. These costs are higher for those who need inpatient care, with $51,241 in medical expenses and $6,110 in lost work.

Cost of violence

Youth violence

Youth violence takes a toll on individuals, families, and communities and comes at a high economic cost to the nation.

A research letter in JAMA Pediatric reports on the economic costs of youth violence, finding that costs rose from $105 billion in 2015 to $122 billion in 2020. The greatest share of the costs were firearm homicides among males.

A research brief in AJPM Publications reporting on the economic cost of youth homicide found that youth homicides alone cost the U.S. $86 billion in 2020. Out of $86 billion, injuries from firearms contributed $78 billion (90%), while injuries caused by cuts or stabbings accounted for over $4 billion in economic costs (4%). There was also an estimated $36 billion in economic cost of nonfatal youth violence injuries.

These findings highlight the significant economic burden of youth violence and the impact of injuries caused by weapons—particularly firearms. The results emphasize the importance of evidence-based programs, policies, and practices to prevent youth violence.

Violence against older adults

The economic cost of violent injuries against older adults (age 60 and older) is also substantial. A recent CDC study found that assault injuries to older adults in the United States cost almost $33 billion in 2022. This reflects a rise in both homicides and nonfatal assaults treated in emergency departments among older adults. Specifically, the rate of nonfatal assaults increased by 31%, while the rate of homicides rose by 26% between 2015 and 2022.

Violence against older adults is preventable. Prevention strategies that address risk factors like poor mental health, substance use disorder, and social isolation are essential and require a coordinated approach across health services, law enforcement, and legal sectors.

Cost of motor vehicle deaths and injuries

More than 30,000 people are killed in motor vehicle crashes each year in the United States. These injuries and deaths have a high economic impact for states. Many evidence-based strategies can significantly reduce the number of injuries and deaths from motor vehicle crashes and their related costs.

Cost of adverse childhood experiences

Adverse childhood experiences (ACEs) are preventable, potentially traumatic events that occur in childhood. Examples of ACEs include neglect, experiencing or witnessing violence, or growing up in a household with substance use problems, mental health problems, or instability due to parental separation or incarceration. A CDC study published in 2023 indicates that nearly 63% of U.S. adults had an ACE, associated with an annual economic burden of $14.1 trillion—$183 billion in medical spending and $13.9 trillion in lost healthy life years. This is $88,000 per affected adult annually and $2.4 million over their lifetime.

There were differences in economic burden by state: The annual economic burden per affected adult was lowest in North Dakota ($45,000) and highest in Arkansas ($155,000). The economic burden was highest among adults with 4 or more ACEs.

ACEs are preventable and related to substantial adult health costs. CDC resources can help states and communities use the best available evidence to prevent ACEs.

Cost of older adult falls

A CDC study published in 2018 showed that the estimated medical cost of older adult falls across the U.S. healthcare system is $50 billion annually. This includes $38 billion paid by Medicare and Medicaid and $12 billion paid by private and other payers.

Older adult falls can be prevented. Initiatives like Stopping Elderly Accidents, Deaths, and Injuries (STEADI) can improve health and decrease the future economic burden of older adult falls. STEADI recommendations include screening older adults to identify their fall risk, assessing at-risk individuals to identify their modifiable fall risk factors, and intervening by using effective strategies to reduce fall risk factors.

Publications on the economics of injuries and violence

Cost of injuries

• Average medical cost of fatal and non-fatal injuries by type in the USA
• Average lost work productivity due to non-fatal injuries by type in the USA
• Costs of fatal and nonfatal firearm injuries in the U.S., 2019 and 2020
  
• Average lost work productivity due to nonfatal injuries by type in the USA
• Average medical cost of fatal and nonfatal injuries by type in the USA
• Economic cost of injury, United States, 2019
• State-level economic costs of fatal injuries, United States, 2019

Cost of violence

• Economic cost of US older adult assault injuries
• Economic burden of health conditions associated with adverse childhood experiences among US adults
• Economic burden of US youth violence injuries
• Lifetime economic burden of intimate partner violence among US adults
• Short-term lost productivity per victim: intimate partner violence, sexual violence, or stalking
• Lifetime economic burden of rape among US adults
• The impact of the low-income housing tax credit on children's health and wellbeing in Georgia
• The economic burden of child maltreatment in the United States, 2015
• Cost-benefit analysis of two child abuse and neglect primary prevention programs for US states
• Economics and violence against children, findings from the Violence Against Children Survey in Nigeria
• Effect of the earned income tax credit on hospital admissions for pediatric abusive head trauma, 1995-2013
• Paid family leave's effect on hospital admissions for pediatric abusive head trauma
• Annual cost of U.S. hospital visits for pediatric abusive head trauma