In 2000, Americans suffered more than 50 million medically treated injuries. This equates to about 20 injuries per 100 males and 17 injuries per 100 females. Nearly 150
000 (or 0.3%) injuries were fatal. The total lifetime cost of injuries occurring in 2000 was approximately $406 billion; $80 billion for medical treatment and $326 billion for lost productivity. Table 2 displays incidence counts and rates (per 100
000 persons) and total lifetime cost of injuries by age category and sex.
Table 2 shows that for males, 92% of injuries occur among those younger than age 65 and 76% occur among those younger than age 45. The greatest rate of injuries—27 per 100 males—occurs among males ages 15–24. For females, the injury trend by age group is different. Although 85% of injuries occur among females younger than age 65, with 65% occurring among those younger than age 45, the greatest rate of injuries occurs among females older than age 75 (24 injuries per 100 females).
Overall, the rate of injury is 20% higher among males than it is among females; however, the rate differs by age group. Males younger than age 24 are more than 30% more likely to suffer an injury than females of the same age group. In contrast, females older than age 75 are about 40% more likely to suffer an injury than their male counterparts.
The overall incidence rate of fatal injuries among males is 77 per 100
000 males, which is more than 2.4 times greater than the rate of fatal injuries among females (32 per 100
000). Males older than age 65 represent only 10% of the US male population, yet this age group sustains 20% of all fatal injuries. Similarly, males older than age 75 represent 4% of the US male population, but account for 13% of fatal injuries. For all age groups of females younger than age 75, the rate of fatal injuries is below 40 per 100
000; for females older than age 75, however, the rate of fatal injuries increases to 148 per 100
In total, medical and productivity losses resulting from injuries in 2000 exceed $400 billion, with 80% of the total resulting from lost productivity. People aged 25–44 (30% of the American population) account for 44% of injury attributable productivity losses; and those older than age 75 (5% of the American population) account for only 2% of injury attributable productivity losses.
The incidence of medically treated injuries captured in this analysis is almost evenly distributed between males and females. Males represent less than 50% of the American population, yet they account for about 70% ($283 billion) of the total cost of injuries. This cost disparity between males and females primarily results from the higher rate of fatal injuries among males and the subsequent higher productivity losses. Additionally, because males, on average, receive higher wages than females, the value of lost productivity that results from a given injury is higher. In contrast, when focusing specifically on injury attributable medical spending, males account for 55% of the total.
Table 3 shows that overall, falls, struck by/against, and other/unclassified injuries accounted for more than 75% of injuries, and MV injuries accounted for an additional 10% of injuries. Although fire/burn, poisoning, drowning/submersion, and firearm/gunshot injuries are comparatively rare, these injuries are far more likely to be fatal than those caused by other mechanisms.
The rate of injuries among males is higher than that among females for every mechanism but falls: females are roughly 16% more likely than males to suffer a fall related injury. This is primarily driven by a high rate of fall related injuries among elderly females (results not shown). In contrast, males are roughly nine times more likely than females to suffer a firearm/gunshot injury and roughly twice as likely than females to suffer a drowning/submersion, cut/pierce, or struck by/against injury.
Combined, MV injuries ($89 billion) and fall injuries ($81 billion) account for more than 40% of the total costs of injuries. The distribution of total costs between medical treatment and lost productivity for these two mechanisms, however, differs considerably: 84% of the total costs of MV injuries result from lost productivity, whereas 67% of the total costs of fall injuries result from lost productivity.
Comparison of 1985 and 2000 incidence rates
The rate of medically treated injuries in the United States in 1985 was 21
330 per 100
We estimate that in 2000, this rate was 18
135 per 100
000 people, a reduction of about 15% unadjusted for age.
Figure 1 compares the incidence rates, by age category, estimated for 1985 and 2000. For those aged 0–44, the incidence rate of injuries declined by more than 20% from 1985 to 2000. In contrast, the incidence rate of injuries among those older than age 45 increased, with people aged 75 and older experiencing a 20% increase.
Figure 1Incidence rate of injuries (per 100000) by age category, 1985 versus 2000.
Figure 2 compares the rate of injuries per 100
000 people in 1985 and 2000 for five categories of mechanisms, showing a decline in the rate of injuries since 1985 for all mechanisms. Firearm/gunshot and fire/burn injuries each decreased by more than 50%. Poisoning, falls, and MV/other road user injuries decreased by 29%, 9%, and 6%, respectively.
Figure 2Incidence rate of injuries (per 100000) by mechanism, 1985 versus 2000.
Table 4 shows the incidence rate of injuries by age, sex, and selected mechanism for 1985 and 2000. For MV/other road user injuries among males, rates declined only marginally for all age groups except those aged 0–14 years of age. For males aged 5–14 years, the rate of MV/other road user injuries nearly doubled from 1985 (957 per 100
000) to 2000 (1733 per 100
000). For MV/other road user injuries among females, no consistent patterns of increase or decline emerged across age groups, although the greatest rate of decline occurred among females aged 75 years and older (from 1807 per 100
000 in 1985 to 837 per 100
000 in 2000).
For falls, the rate of injuries decreased for males in every age category; similarly, rates decreased for females up to age 45. But among older females (aged 75 years and older) the fall related injury rate more than doubled from 1985 (6576 per 100
000) to 2000 (14
104 per 100
000). For firearms, the rate of injuries decreased from 1985 to 2000 for females in every age category and for males aged 15 years and older. For poisoning, the rate of injuries marginally declined from 1985 to 2000 for most gender/age categories, with the exception of females aged 15–24 years (where the rate increased fivefold) and females aged 65–74 years (where the rate increased twofold).
While the overall incidence of injuries declined 15% from 1985 to 2000, the total medical costs of injuries (in real dollars) declined roughly 20%. The decrease in cost, although driven in large part by the decrease in injury incidence, may also be the result of advances in trauma care, a shift toward managed care, and successful injury prevention efforts that minimize the harm resulting from injuries (for example, safety belts, helmets).