Ian RH Rockett, Department of Epidemiology and Biostatistics, West Virginia University School of Public Health, One Medical Center Drive, Morgantown, WV, 26506-9190, USA.Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY, 14642, USA.Follow
Bina Ali, Pacific Institute for Research and Evaluation, 4061 Powder Mill Rd, Beltsville, MD, 20705, USA.
Eric D. Caine, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY, 14642, USA.
Donald S. Shepard, Cost and Value Group, Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA, 02453, USA.
Aniruddha Banerjee, Department of Geography, Indiana University-Purdue University at Indianapolis, Cavanaugh Hall 441, 425 University Blvd., Indianapolis, IN, 46202, USA.
Kurt B. Nolte, Department of Pathology, University of New Mexico School of Medicine, MSC08-4640, Albuquerque, NM, 87131, USA.
Hilary S. Connery, McLean Hospital, 115 Mill Street, Mail Stop 222, Belmont, MA, 02478-1064, USA.Department of Psychiatry, Harvard Medical School, 2 West, Room 305, 401 Park Drive, Boston, MA, 02215, USA.
G Luke Larkin, Northeast Ohio Medical University, 4209 St. Rt. 44, PO Box 95, Rootstown, OH, 44272, USA.
Steven Stack, Department of Criminology and Criminal Justice, Wayne State University, 3293 Faculty/Administration Building (FAB) 656 W. Kirby St, Detroit, MI, 48202, USA.Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Tolan Park Medical Building, 3901 Chrysler Service Drive, Detroit, MI, 48201-2167, USA.
Franklin M M White, Department of Community Health and Epidemiology, Dalhousie University, 5790 University Ave, Halifax, NS, B3H 1V7, Canada.
Haomiao Jia, Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA. School of Nursing, Columbia University, 560 W 168th St, New York, NY, 10032, USA.
Jeralynn S. Cossman, College for Health, Community and Policy, University of Texas-San Antonio, One UTSA Circle, San Antonio, TX, 78249-3209, USA.
Judith Feinberg, Departments of Behavioral Medicine and Psychiatry and Medicine, Infectious Diseases, West Virginia University School of Medicine, 30 Chestnut Ridge Rd, Morgantown, WV, 26506, USA.
Amanda N. Stover, Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA.School of Nursing, Columbia University, 560 W 168th St, New York, NY, 10032, USA.
Ted R. Miller, Pacific Institute for Research and Evaluation, 4061 Powder Mill Rd, Beltsville, MD, 20705, USA.Centre for Population Health Research, Curtin University, 208 Kent St, Bentley, WA, 6102, Australia.

Document Type

Article

Publication Date

2-8-2023

Abstract

BACKGROUND: Estimating the economic costs of self-injury mortality (SIM) can inform health planning and clinical and public health interventions, serve as a basis for their evaluation, and provide the foundation for broadly disseminating evidence-based policies and practices. SIM is operationalized as a composite of all registered suicides at any age, and 80% of drug overdose (intoxication) deaths medicolegally classified as 'accidents,' and 90% of corresponding undetermined (intent) deaths in the age group 15 years and older. It is the long-term practice of the United States (US) Centers for Disease Control and Prevention (CDC) to subsume poisoning (drug and nondrug) deaths under the injury rubric. This study aimed to estimate magnitude and change in SIM and suicide costs in 2019 dollars for the United States (US), including the 50 states and the District of Columbia.

METHODS: Cost estimates were generated from underlying cause-of-death data for 1999/2000 and 2018/2019 from the US Centers for Disease Control and Prevention's (CDC's) Wide-ranging ONline Data for Epidemiologic Research (WONDER). Estimation utilized the updated version of Medical and Work Loss Cost Estimation Methods for CDC's Web-based Injury Statistics Query and Reporting System (WISQARS). Exposures were medical expenditures, lost work productivity, and future quality of life loss. Main outcome measures were disaggregated, annual-averaged total and per capita costs of SIM and suicide for the nation and states in 1999/2000 and 2018/2019.

RESULTS: 40,834 annual-averaged self-injury deaths in 1999/2000 and 101,325 in 2018/2019 were identified. Estimated national costs of SIM rose by 143% from $0.46 trillion to $1.12 trillion. Ratios of quality of life and work losses to medical spending in 2019 US dollars in 2018/2019 were 1,476 and 526, respectively, versus 1,419 and 526 in 1999/2000. Total national suicide costs increased 58%-from $318.6 billion to $502.7 billion. National per capita costs of SIM doubled from $1,638 to $3,413 over the observation period; costs of the suicide component rose from $1,137 to $1,534. States in the top quintile for per capita SIM, those whose cost increases exceeded 152%, concentrated in the Great Lakes, Southeast, Mideast and New England. States in the bottom quintile, those with per capita cost increases below 70%, were located in the Far West, Southwest, Plains, and Rocky Mountain regions. West Virginia exhibited the largest increase at 263% and Nevada the smallest at 22%. Percentage per capita cost increases for suicide were smaller than for SIM. Only the Far West, Southwest and Mideast were not represented in the top quintile, which comprised states with increases of 50% or greater. The bottom quintile comprised states with per capita suicide cost increases below 24%. Regions represented were the Far West, Southeast, Mideast and New England. North Dakota and Nevada occupied the extremes on the cost change continuum at 75% and - 1%, respectively.

CONCLUSION: The scale and surge in the economic costs of SIM to society are large. Federal and state prevention and intervention programs should be financed with a clear understanding of the total costs-fiscal, social, and personal-incurred by deaths due to self-injurious behaviors.

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