Economic Cost of Injury — United States, 2019

Unintentional and violence-related injuries, including suicide, homicide, overdoses, motor vehicle crashes, and falls, were among the top 10 causes of death for all age groups in the United States and caused nearly 27 million nonfatal emergency department (ED) visits in 2019.*^,† CDC estimated the economic cost of injuries that occurred in 2019 by assigning costs for medical care, work loss, value of statistical life, and quality of life losses to injury records from the CDC’s Web-based Injury Statistics Query and Reporting System (WISQARS).^§ In 2019, the economic cost of injury was $4.2 trillion, including $327 billion in medical care, $69 billion in work loss, and $3.8 trillion in value of statistical life and quality of life losses. More than one half of this cost ($2.4 trillion) was among working-aged adults (aged 25–64 years). Individual persons, families, organizations, communities, and policymakers can use targeted proven strategies to prevent injuries and violence. Resources for best practices for preventing injuries and violence are available online from CDC’s National Center for Injury Prevention and Control.^¶

The economic cost estimate for injuries that occurred in 2019 uses the societal perspective, including tangible and intangible costs to multiple payers, and a 1-year time horizon (period over which costs are assessed) for nonfatal injuries. Costs are presented in 2019 U.S. dollars (USD). WISQARS nonfatal injury counts are hospital ED injury visits from the nationally representative National Electronic Injury Surveillance System – All Injury Program. WISQARS fatal injury counts are from CDC’s National Vital Statistics System mortality data.

Medical and work loss costs (1,2) were adjusted for patient clinical and demographic characteristics, including comorbidities, sex, and age, and modified to 2019 USD.** Medical costs were assigned to WISQARS records by injury outcome (fatal or nonfatal), mechanism (e.g., fall), intent (e.g., unintentional), and place of death (e.g., inpatient hospital) or ED visit disposition (treated and released or hospitalized, including transferred). Work loss costs for nonfatal injuries were assigned by injury mechanism and ED visit disposition to injured persons of all ages; this approach assumes injured children and older adults incur lost productivity among working-aged adult caregivers. Aggregated medical and work loss costs (e.g., combined intents by mechanism or combined mechanisms by ED visit disposition) from reference sources were assigned when specific estimates by intent or mechanism were not available.

The cost of injury mortality includes value of statistical life, a monetary estimate of the collective value placed on mortality risk reduction as derived in research studies through revealed preferences (e.g., observed wage differences for dangerous occupations) or stated preferences from surveys of individual persons’ willingness to pay for mortality risk reduction (3). Value of statistical life estimates were assigned by decedent age: 0–17 years, $16.9 million (4); 18–65 years, $10.7 million (3); and values descending from $6 million (aged 66 years) to $410,000 (aged ≥100 years), reflecting the estimate for persons aged 18–65 years adjusted for older adults’ decreasing general life expectancy and baseline quality of life. Cost of nonfatal injury morbidity includes quality of life losses measured in terms of quality-adjusted life years (QALY; 1 QALY equals 1 year of perfect health) (5) and valued at $540,000 per QALY (3). Injury count, rate per 100,000 population, cost by type (medical, work loss, value of statistical life, and quality of life loss), and total cost are reported by intent, sex, and age group. All reported data can be queried online using WISQARS. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.^††

In 2019, the economic cost of injury was $4.2 trillion, including $327 billion in medical care, $69 billion in work loss, and $3.8 trillion in value of statistical life and quality of life losses (Table). The economic costs were $2.2 trillion for fatal injuries and $2.0 trillion for nonfatal injuries. The number of injury deaths and associated economic cost were higher among males (169,628 and $1.6 trillion, respectively) than among females (76,413 and $607 billion, respectively). The cost of nonfatal injury was similar for males and females ($1 trillion). Except for nonfatal self-harm, the age-adjusted rate, number, and economic cost for all injury outcomes (fatal and nonfatal) and intents (unintentional, homicide or assault) were higher for males than for females.

Economic cost was highest for persons aged 25–44 and 45–64 years ($1.2 trillion each), followed by those aged ≥65 years ($906 billion), 15–24 years ($512 billion), and 0–14 years ($396 billion). Although the injury fatality rate was highest among those aged ≥65 years (132.1 per 100,000; mostly unintentional [112.0]), the economic cost of fatal injuries was higher for those aged 25–44 years ($808 billion) and 45–64 years ($755 billion) than for those aged ≥65 years ($261 billion) because of higher value of statistical life cost. The economic cost of suicide deaths was highest among those aged 25–44 years ($167 billion) and 45–64 years ($174 billion). The economic cost of deaths from homicide was highest among those aged 25–44 years ($94 billion), followed by those aged 15–24 years ($56 billion). The economic cost of nonfatal injuries was highest among those aged ≥65 years ($645 billion), primarily because of quality of life loss costs from unintentional injuries, followed by those aged 45–64 years ($426 billion), 25–44 years ($405 billion), 0–14 years ($302 billion), and 15–24 years ($245 billion). The economic cost of nonfatal injuries from assault and self-harm were highest among those aged 25–44 years ($66 billion and $10 billion, respectively).

Corresponding author: Cora Peterson, vsm2@cdc.gov, 770-488-0699.

¹Division of Injury Prevention, National Center for Injury Prevention and Control, CDC.

References

1. Peterson C, Xu L, Barnett SBL. Average lost work productivity due to non-fatal injuries by type in the USA. Inj Prev 2021;27:111–7. https://doi.org/10.1136/injuryprev-2019-043607 PMID:32366517
2. Peterson C, Xu L, Florence C. Average medical cost of fatal and non-fatal injuries by type in the USA. Inj Prev 2021;27:24–33. https://doi.org/10.1136/injuryprev-2019-043544 PMID:31888976
3. Office of the Assistant Secretary for Planning and Evaluation. Guidelines for regulatory impact analysis. Washington, DC: US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation; 2016. https://aspe.hhs.gov/sites/default/files/migrated_legacy_files//171981/HHS_RIAGuidance.pdf
4. Office of Child Care, Administration for Children and Families, US Department of Health and Human Services. Child Care and Development Fund (CCDF) program. Final rule. Fed Regist 2016 Sep30;81(190):67438–595. PMID:27726322
5. Lawrence B, Miller T. Quality of life loss estimation methods for the WISQARS Cost of Injury Module. Calverton, MD: Pacific Institute for Research and Evaluation; 2020. https://www.cdc.gov/injury/wisqars/pdf/PIRE_WISQARS_cost_injury_quality_life_loss_estimation_methods-508.pdf
6. Florence C, Haegerich T, Simon T, Zhou C, Luo F. Estimated lifetime medical and work-loss costs of emergency department-treated nonfatal injuries—United States, 2013. MMWR Morb Mortal Wkly Rep 2015;64:1078–82. https://doi.org/10.15585/mmwr.mm6438a5 PMID:26421663
7. Florence C, Simon T, Haegerich T, Luo F, Zhou C. Estimated lifetime medical and work-loss costs of fatal injuries—United States, 2013. MMWR Morb Mortal Wkly Rep 2015;64:1074–7. https://doi.org/10.15585/mmwr.mm6438a4 PMID:26421530
8. Aldy JE, Viscusi WK. Adjusting the value of a statistical life for age and cohort effects. Rev Econ Stat 2008;90:573–81. https://doi.org/10.1162/rest.90.3.573

Abbreviation: USD = U.S. dollars.
* In millions of 2019 USD.
^† Fatal all intents estimates include injuries with legal intervention intent, undetermined intent, unknown sex, and unknown age.
^§ Per 100,000. Age-adjusted rate is presented for “Total,” “Male,” and “Female” columns.
^¶ Nonfatal injuries are an estimated number of hospital visits for injury care that start in an emergency department (with disposition treated and released, transferred, or hospitalized; visits with observed, left against medical advice, and unknown disposition were not included) based on a nationally representative probability sample of hospitals.
** Nonfatal all intents estimates include injuries with legal intervention intent, unknown sex, and unknown age. Nonfatal assault, self-harm, and legal intervention include cases that are confirmed or suspected; all other cases are considered unintentional.