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Background Standardized methodologies for assessing economic burden of injury at the national or international level do not exist. Objective To measure national incidence, medical costs, and productivity losses of medically treated injuries using the most recent data available in the United States, as a case study for similarly developed countries undertaking economic burden analyses. Method The authors combined several data sets to estimate the incidence of fatal and non-fatal injuries in 2000. They computed unit medical and productivity costs and multiplied these costs by corresponding incidence estimates to yield total lifetime costs of injuries occurring in 2000. Main outcome measures Incidence, medical costs, productivity losses, and total costs for injuries stratified by age group, sex, and mechanism. Results More than 50 million Americans experienced a medically treated injury in 2000, resulting in lifetime costs of $406 billion; $80 billion for medical treatment and $326 billion for lost productivity. Males had a 20% higher rate of injury than females. Injuries resulting from falls or being struck by/against an object accounted for more than 44% of injuries. The rate of medically treated injuries declined by 15% from 1985 to 2000 in the US. For those aged 0–44, the incidence rate of injuries declined by more than 20%; while persons aged 75 and older experienced a 20% increase. Conclusions These national burden estimates provide unequivocal evidence of the large health and financial burden of injuries. This study can serve as a template for other countries or be used in intercountry comparisons.

In this study, we investigate the association between exposure to adverse childhood experiences and long-term disability using receipt of Social Security Disability Insurance (SSDI) benefits as a proxy for disability as a measure of economic impact. Survey data were obtained over an eight-month period (ending in March 2014) from a convenience sample of patients attending two private psychology practices, and parishioners attending a local church in western Nebraska. Data were collected using the Adverse Childhood Experiences (ACE) Study questionnaire, which collects information on eight areas of exposure (e.g., abuse and household dysfunction). Respondents were also asked for the status of SSDI applications and several demographic questions. The Student’s t-test and the two-sample test of proportions were used to test for statistically significant differences in total ACE score and individual ACE Study questions, respectively, by receipt of SSDI. The response rate was 64% (n = 96 out of 150) and respondents were mostly female (75%) with an average age of 48.2 years (range: 19–92). The mean total ACE score was significantly larger, indicating more adverse exposures, for respondents who received SSDI benefits (p = 0.037) compared to those who did not receive benefits. Exposure to sexual abuse (p = 0.014), neglect (p = 0.046), and a household member with mental illness (p = 0.012) were significantly associated with receipt of SSDI. Respondents who received SSDI were significantly more likely to report more exposure to adverse childhood experiences, particularly child maltreatment. These results suggest that the economic impact of child maltreatment may be underestimated if the long-term effect on the ability to work is not included. No previous studies have been conducted to determine the association of adverse childhood experiences and costly SSDI benefits. Investigating this association will provide policy makers with an understanding of the true economic burden of these events and, ultimately, lead to more resources to prevent these exposures.

Background Assessing societal willingness-to-pay (WTP) is one approach for monetising potential benefits of an intervention. In the field of child maltreatment (CM), such estimates are scarce and have rarely been compared between populations from different countries. Aims/Objectives/Purpose This study estimates WTP for an intervention intended to reduce the mortality risk associated with CM, comparing an Ecuadorian to US population. Methods We used the contingent valuation method to ask WTP in increased annual taxes (in US$) for a 50% reduction in CM mortality risk. The US population (n=117) was selected by random-digit dial in 2008. The Ecuadorian population (n=78) was selected by convenience from different shopping districts in 2012. The 2008 WTP estimates were inflated to 2012 US$ for comparison. The maximum likelihood function was estimated using interval regression in STATA. Other covariates tested in the model included age, gender, race, and history of CM abuse. Results/Outcomes The WTP for a 50% reduction in the risk of a child being killed by a caretaker or parent was $167 ($146-$190, 95% CI) in Ecuador, and $215 ($185 to $246, 95% CI) in the US, which was significantly different at p=0.08 when tested in the reduced model. In the full model, none of the covariates including country were significant. Significance/Contribution to the Field WTP to prevent CM death varies marginally from one population to another, likely tempered by differences in purchasing power. Given the overall low probability of CM death, the value placed on a life saved from CM in either population is considerable. This is an abstract of a presentation at Safety 2012, the 11th World Conference on Injury Prevention and Safety Promotion, 1-4 October 2012, Michael Fowler Center, Wellington, New Zealand. Full text does not seem to be available for this abstract.

Background Exposure to violence affects an individual9s overall health. For example, reductions in the mental health and social functioning domains of health-related quality of life (HRQoL) strongly correlate with domestic violence. Purpose There is a gap in the literature on the influence violence on HRQoL for African-American teenagers in particular. Methods African-American teenagers (N=491) enrolled in a behavioural intervention self-reported during waves of data collection, beginning at age (mean) 16.0 through age (mean) 18.5, exposure to violent crime, propensity for aggression, perpetration of violence, and dimensions of HRQoL as defined by the SF-36. We used a fixed-effects linear regression model to investigate the impact of being a violence victim or perpetrator on each of the eight dimensions and two component summary scales of the SF-36, while controlling for high depressive symptoms and socio-economic risk status. Differences are significant at a p Results Considering the eight dimensions of HRQoL, for victims we found a significant reduction in the ‘role-limitations’ domain for victims and, for perpetrators we found a significant decrease in the ‘role-limitations’ and ‘mental health’ domains. Regarding the component summary scales, for perpetrators we found significant decreases in both the physical and mental summary scales. Significance Our results agree with other published studies that suggest violence significantly decreases a victim9s overall mental health. However, for violence victimisation and perpetration, we found that violence might also impair African-American teenagers9 ability to handle ‘normal or usual daily activities,’ which may indicate that violence interferes with their societal and household productivity.