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The Health Costs of Gun Violence: How the U.S. Compares to Other Countries

Photo, Man looks at bullethole in store window

A pedestrian walks past bullet holes in the window of a storefront on South Street in Philadelphia on June 5, 2022. The U.S. has the highest overall rate of death from firearms compared to 13 other high-income countries — it’s nearly five times that of France, the nation with the second-highest rate. Photo: Kriston Jae Bethel/AFP via Getty Images

A pedestrian walks past bullet holes in the window of a storefront on South Street in Philadelphia on June 5, 2022. The U.S. has the highest overall rate of death from firearms compared to 13 other high-income countries — it’s nearly five times that of France, the nation with the second-highest rate. Photo: Kriston Jae Bethel/AFP via Getty Images

Toplines
  • The U.S. is the only high-income country with more civilian-owned guns than people

  • Not only does gun violence claim tens of thousands of lives in the United States every year, but it also burdens the health care system with more than $1 billion in medical costs

Toplines
  • The U.S. is the only high-income country with more civilian-owned guns than people

  • Not only does gun violence claim tens of thousands of lives in the United States every year, but it also burdens the health care system with more than $1 billion in medical costs

Firearm mortality in the United States has been well documented, and for good reason: far more Americans die of firearm-related causes than do residents of any other high-income country. Firearms are the leading cause of death for children in the U.S. and the weapon used most in interpersonal violence against women.

The Centers for Disease Control and Prevention (CDC) estimates that nearly 49,000 Americans died from firearm-related causes in 2021, up from about 45,000 in 2020.1 In 2019, firearms accounted for 10.4 deaths for every 100,000 people in the U.S., around five times greater than in the countries with the second- and third-highest death rates, France (2.2) and Switzerland (2.1).

Less publicized, however, is how gun violence burdens the health care system. Each year in the U.S., firearm-related injuries lead to roughly 30,000 inpatient hospital stays and 50,000 emergency room visits, generating more than $1 billion in initial medical costs. In 2020 alone, deaths from these injuries cost $290 million, an average of $6,400 per patient. Medicaid and other public insurance programs absorbed most of these costs.

But the impact of gun violence reaches far beyond the hospital room. Firearm injuries leave victims with hefty medical bills. Medical spending increases an average of $2,495 per person per month in the year following the injury. Survivors are also more likely to develop mental health conditions and substance use disorders, areas in which the U.S. has poor outcomes.

In the following seven charts, we illustrate how gun violence affects Americans compared to people in 13 other high-income countries. The data are drawn from the Institute for Health Metrics and Evaluation’s (IHME) Global Burden of Disease database, the Small Arms Survey’s Global Firearms Holdings database, and the U.S. Government Accountability Office’s Firearm Injuries: Health Care Service Needs and Costs report (see “Data Sources and Methods” for details).

Highlights

  • The U.S. has the highest overall rate of death from firearms, nearly five times that of France, the nation with the second-highest rate.
  • Women are significantly more likely to be killed by a firearm in the U.S. than in other high-income countries.
  • The U.S. is the only high-income country where the number of civilian-owned guns exceeds the total number of people.
  • Medicaid, the program for low-income Americans that disproportionately enrolls people of color, pays most of the costs associated with hospital care for firearm injuries.
Gumas_health_costs_gun_violence_how_us_compares_Exhibit_01
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DATA SOURCES AND METHODS

This analysis draws from three main data sources:

Global Burden of Disease (Institute for Health Metrics and Evaluation, or IHME). The 2019 Global Burden of Disease study provides a comprehensive picture of mortality and disability across countries, time, age, and sex. It quantifies health loss from hundreds of diseases, injuries, and risk factors. The study calculated firearm mortality because of physical violence by firearm, self-harm by firearm, and unintentional firearm injuries. The raw numbers of deaths for all three were combined to create an overall firearm mortality number, which was then analyzed and age-standardized to the WHO standard population. Details on their methods are available here. This process was applied to Exhibit 1 (total firearm morality) and Exhibit 4 (female firearm mortality).

Small Arms Survey. The Small Arms Survey focuses on issues such as armed violence, arms trafficking, stockpile management, arms control, and more. They conduct extensive research on global trends on small arms and armed violence. The Global Firearms Holdings database estimates the number of civilian, military, and law enforcement firearms, although we focused only on civilian-held firearms. More information about their methods is available here.

United States Government Accountability Office. The U.S. Government Accountability Office’s 2021 report presented data on the impact of firearm injuries on health care costs and needs. Information about their methods is available here.

ACKNOWLEDGMENTS

The authors would like to thank Dave Radley, Aishu Balaji, Chris Hollander, Paul Frame, Celli Horstman, Sara Federman, Joseph Betancourt, Akeiisa Coleman, Deb Lorber, Rachel Nuzum, and Bethanne Fox from the Commonwealth Fund for their assistance in producing this chartpack.

NOTES
  1. Firearm mortality deaths included ICD Codes W32-34 (firearm discharge), X72-X74 (intentional self-harm by firearm), X93-95 (assault by firearm), Y22-24 (undetermined intent of firearm discharge), and Y35 (legal intervention involving firearm discharge).

Publication Details

Date

Contact

Evan D. Gumas, Research Associate, International Health Policy and Practice Innovations, The Commonwealth Fund

[email protected]

Citation

Evan D. Gumas, Munira Z. Gunja, and Reginald D. Williams II, “The Health Costs of Gun Violence: How the U.S. Compares to Other Countries,” chartpack, Commonwealth Fund, Apr. 2023. https://doi.org/10.26099/a2at-gy62