In this book the authors present data from the year 2000 regarding the incidence of injuries in the United States and the associated economic burden.
Chapter 1 deals with the incidence of accidental injuries during the year 2000 using the ICD‐9 classification and based on data from 50.1 million injured persons. The authors use tables and graphs to present information regarding demographics, cause of accident, body system affected, injury severity and injury patterns.
Chapter 2 discusses the lifetime costs resulting from accidental injuries. It is estimated that the total cost of injury to the US health system in 2000 was $80.2 billion, of which traumatic deaths accounted for $1.1 billion, inpatient costs for $33.7 billion and outpatient costs for $45.4 billion. Although only 4% of injured subjects need to be hospitalised, 42% of all medical costs are associated with this group of patients. As the incidence of trauma is generally lower in women than in men, women account for a smaller proportion of the costs of injury. The elderly (>75 years of age), who constitute 5% of the US population but in 2000 were involved in 6% of accidents resulting in injuries, consume a comparatively larger share of medical resources ($12.6 billion, equivalent to 16% of the total). More than two‐thirds of all costs are attributable to traffic accidents (24%) and falls (45%).
Chapter 3 analyses the loss of productive years caused by trauma. For the year 2000 alone, the productive losses are estimated at $326 billion ($142 billion for lethal accidents, $58.7 billion for injuries treated in the hospital and $125.3 billion for injuries treated on an outpatient base). Again, most of these costs to the general economy can be attributed to traffic accidents, followed by falls.
Chapter 4 estimates the lifelong total costs after accidental injury to be $406 billion for the year 2000: $143 billion for lethal accidents, $92 billion for injuries leading to hospitalisation and $171 billion for injuries treated on an outpatient base. Lethal accidents (0.3%) and accidents leading to hospitalisation (3.7%) together account for 58% of the total cost. The total consists mainly (80%) of lost productivity, with the remaining 20% being the costs of medical treatment.
The last chapter analyses the economic burden of trauma. The authors emphasise the impact of the two high‐risk groups, males between 15 and 24 years and women over 75 years. Compared with the year 1985 the economic burden of injuries fell by 15% in the year 2000, partly because of a reduced incidence of injury in the younger (<45 years old) age group. However, the incidence of trauma in people over 45 has risen since 1985.
The authors conclude that the enormous cost accrued by trauma, which is mostly shouldered by society as a whole, certainly justifies more investment in preventative measures.
From a German and European perspective we conclude the following: Most European statistics on accidents are based on police reports and thus do not compare to such differentiated data sets as presented here. The only exceptions being the German workman's comp system, which does provide detailed data on work related injuries and their costs, and the Trauma Register of the German Association of Trauma Surgeons with its outcome data on more than 20000 severely injured.
In summary, this exciting and comprehensive work by Finkelstein et al. demonstrates once again that the US clearly leads Europe in recording and analysing accident statistics. Perhaps the next edition of the book could include a sixth chapter on the costs of injury prevention or how much is spent to keep economic cost at £406 billion.