By Emily Heller       

Fatal and nonfatal injuries cost the U.S. a total of $671 billion in 2013, according to new research from the Centers for Disease Control and Prevention (CDC). This figure includes both medical costs and the work loss costs (estimated lost wages) associated with injuries.

Injury is the leading cause of death of children and adults between the ages of 1 and 44 in the U.S., causing more deaths than noncommunicable diseases and infectious diseases combined.

Injuries and violence place a large financial burden on communities and the health care system, in addition to their considerable health, emotional and social costs. They are responsible for millions of emergency department visits and hospitalizations each year and billions of dollars in financial costs, making injury prevention a key public health issue for states.

The research also sheds light on the types of injuries that are taking the biggest economic toll on the country. States may use this information to guide their prevention activities and set legislative priorities.

Unintentional injuries—which include motor vehicle accidents, poisonings and falls, among others—accounted for the majority of both fatal and nonfatal injury costs.

Nonfatal injuries caused nearly a third of all emergency department (ED) visits in 2010 and accounted for more than two-thirds of the total cost of injuries ($457 billion) in 2013. Fatal injuries were responsible for the remaining $214 billion (32 percent) of total injury costs in 2013. Deaths due to unintentional injuries (vs. suicide and homicide, the other top causes of injury-related death) accounted for more than half of the fatal injury medical and work loss costs.  

Males accounted for the majority of costs for both injury deaths (78 percent of costs) and nonfatal injuries (63 percent of costs).

Fortunately, promising strategies exist that policymakers can consider to reduce the frequency and severity of costly injuries in their states. For example, state leaders may wish to focus on injuries that occur frequently and have high costs, such as motor vehicle injuries, drug poisonings and falls.

Transportation-related injuries accounted for 23 percent of fatal injury costs and 21 percent of nonfatal injury costs in 2013, making them a major public health issue for states. Evidence-based policies shown to prevent motor vehicle accident injuries include:

• Enacting child passenger restraint laws.
• Passing primary enforcement seat belt laws, which permit police officers to pull over and ticket car drivers and passengers for not wearing a seat belt.
• Creating graduated driver licensing (GDL) programs, which require new drivers to acquire driving privileges (such as driving at night or with passengers) in stages.
• Establishing sobriety checkpoints.
• Requiring drivers convicted of driving under the influence of drugs or alcohol to install ignition interlocks in their cars, which test the driver’s  breath and prevent the car from starting if the driver’s blood alcohol concentration is over the legal limit.

NCSL’s State Traffic Safety Legislation Database has additional information on state legislation addressing motor vehicle injuries.

More than a quarter (27 percent) of all fatal injury costs were due to drug poisonings in 2013, according to the CDC. Between 1999 and 2013, the rate of drug poisoning deaths doubled. State leaders may want to address this important issue by targeting prescription drug overdoses, an important component of drug poisoning prevention. Strategies for policymakers to consider include:

• Strengthening state Prescription Drug Monitoring Programs (PDMPs) through measures such as facilitating data sharing and requiring prescribers of controlled substances to participate in the program.
• Enacting legislation regulating or requiring  oversight of pain management clinics.
• Creating state opioid prescribing guidelines for providers.
• Passing drug overdose immunity, or “Good Samaritan,” laws to encourage people experiencing a drug overdose to get medical attention and to increase access to drugs that counter the effects of an overdose.
• Creating and funding statewide public awareness campaigns.

Falls accounted for 37 percent of nonfatal injury costs and 5 percent of fatal injury costs. State policymakers may want to consider prevention activities for elderly falls, a major cause of traumatic brain injury and death. Promising policies include:

• Establishing and funding an elderly fall prevention program and statewide public awareness campaign
• Incentivizing primary care providers to incorporate fall risk assessment and fall prevention into routine care, through resources such as the CDC’s STEADI (Stopping Elderly Accidents, Deaths and Injuries) toolkit for providers
• Supporting continuing medical education courses for providers that include information on fall prevention   

For more information on state efforts to reduce the burden of injuries and violence, please visit NCSL’s Injury Prevention Legislation Database, which provides up-to-date information on injury prevention legislation introduced in all 50 states and the District of Columbia. 

Emily Heller is a research analyst in NCSL's Health Program.

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