Comprehensive Analysis of US Health Care Spending on Injuries.

BACKGROUND

Traumatic injury affects every age group, payer, and care setting in the United States, yet how injury-related spending distributes across these dimensions has not been comprehensively quantified.

OBJECTIVE

To estimate US health care spending on injuries in 2022 by mechanism, payer, and type of care.

METHODS

Cross-sectional analysis using the Institute for Health Metrics and Evaluation's Disease Expenditure Project, which harmonizes over 40 billion claims across Medicare, Medicaid, and commercial payers. Spending was attributed to injury diagnoses, adjusted for comorbidities, and stratified across 38 age and sex groups, 9 mechanism categories, 4 payers, and 5 types of care to evaluate for distinct spending phenotypes.

RESULTS

US injury spending totaled $106.7 billion in 2022, with 52% occurring outside acute care settings and ambulatory care ($42.2B, 40%) nearly equaling inpatient care ($42.3B, 40%). Falls predominated ($56.2B, 53%), followed by transport injuries ($23.3B, 22%). Distinct spending phenotypes varied by mechanism: falls concentrated among women aged 65 and older with heavy post-acute utilization, while firearms and assault concentrated among men aged 15 to 39 with predominantly acute care. Payer burden stratified by mechanism (falls: 40% Medicare; transport injuries: 58% private; assault: 52% Medicaid). For patients under age 65, private insurance spent 3 times more per inpatient encounter than Medicaid across all mechanisms, while Medicare and private insurance had similar spending per inpatient encounter for those over 65.

CONCLUSIONS

This first comprehensive, claims-based accounting of the nearly $107 billion spent annually on injuries in the United States reveals distinct spending phenotypes defined by mechanism, demographics, and payer, with direct implications for how trauma systems are planned, financed, and sustained.