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State-Level Lifetime Medical and Work-Loss Costs of Fatal Injuries — United States, 2014


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Feijun Luo, PhD1; Curtis Florence, PhD1 (View author affiliations)

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Summary

What is already known about this topic?

Injuries are a leading cause of death in the United States. Injury-associated deaths result in a substantial economic burden to the United States: the total estimated lifetime medical and work-loss costs were $214 billion in 2013. Injury and violence prevention strategies can save lives and reduce costs.

What is added by this report?

Lifetime costs and lifetime costs per capita were calculated for each of the 50 states and the District of Columbia (DC) and for each of four injury intent categories (all intents, unintentional, suicide, and homicide) for 2014. Economic burdens varied widely among the states and DC. Lifetime costs per capita ranged from $1,233 (New Mexico) to $491 (New York) among fatal injuries of all intents, from $815 (West Virginia) to $261 (Maryland) among unintentional injuries, from $338 (Alaska) to $107 (New Jersey) among suicides, and from $273 (DC) to $24 (Hawaii) for homicides.

What are the implications for public health practice?

States can engage more effectively and efficiently in injury prevention if they are aware of the economic burden of injuries, identify areas for immediate improvement, and devote necessary resources to those areas. States that consistently have lower lifetime costs per capita across different intents of injuries might have successful injury prevention experiences that could be shared with states with higher per capita costs.

Injury-associated deaths have substantial economic consequences in the United States. The total estimated lifetime medical and work-loss costs associated with fatal injuries in 2013 were $214 billion (1). In 2014, unintentional injury, suicide, and homicide (the fourth, tenth, and seventeenth leading causes of death, respectively) accounted for 194,635 deaths in the United States (2). In 2014, a total of 199,756 fatal injuries occurred in the United States, and the associated lifetime medical and work-loss costs were $227 billion (3). This report examines the state-level economic burdens of fatal injuries by extending a previous national-level study (1). Numbers and rates of fatal injuries, lifetime costs, and lifetime costs per capita were calculated for each of the 50 states and the District of Columbia (DC) and for four injury intent categories (all intents, unintentional, suicide, and homicide). During 2014, injury mortality rates and economic burdens varied widely among the states and DC. Among fatal injuries of all intents, the mortality rate and lifetime costs per capita ranged from 101.9 per 100,000 and $1,233, respectively (New Mexico) to 40.2 per 100,000 and $491 (New York). States can engage more effectively and efficiently in injury prevention if they are aware of the economic burden of injuries, identify areas for immediate improvement, and devote necessary resources to those areas.

The numbers of injury-associated deaths in each of the 50 states and DC in 2014 were obtained from the National Vital Statistics System, and state-level lifetime costs were obtained from the Web-based Injury Statistics Query and Reporting System database (3). Injury death rates were calculated using the U.S. Census Bureau’s bridged race population estimates for 2014. Lifetime costs, which include lifetime medical and work-loss costs, were computed by multiplying the number of injury deaths by average costs of treating injuries and earnings in 2010, adjusted to 2014 prices. Medical costs were derived from various sources that measure the costs of transport, health care in multiple settings, including emergency departments, hospitals, and nursing homes, and examination by a coroner or medical examiner (4). Work-loss costs were developed using earnings data from the U.S. Census Bureau’s Current Population Survey and life expectancy data from CDC’s National Center for Health Statistics. Numbers of deaths, rates, lifetime costs, and lifetime costs per capita (lifetime costs divided by the state population) were examined for each state and DC. Lifetime costs per capita were used for comparisons across states. Four intents of fatal injuries were considered: all intents,* unintentional, suicide, and homicide. For each intent, state-level lifetime costs were estimated for the total population, for males and females, and for all intents. State-level lifetime costs were also estimated for three age groups: young (0–24 years), middle (25–64 years), and older (≥65 years). State-level lifetime costs per capita were provided for the total population for each intent. In some state-intent-population combinations, average medical costs were statistically unstable, but these costs accounted for <1% or <5% of average lifetime costs. When both average medical costs and average work-loss costs were statistically unstable or when the mortality rates were unstable or missing, lifetime costs or lifetime costs per capita were not presented.

Injuries from All Intents

Injury mortality rates (per 100,000), lifetime costs (in 2014 U.S. dollars), and lifetime costs per capita (in 2014 U.S. dollars) varied widely among the 50 states and DC for each of the four intents. Overall, total injury-related mortality rate and lifetime costs per capita ranged from 101.9 per 100,000 and $1,233, respectively (New Mexico) to 40.2 and $491 (New York) (Table 1). The rates of overall male and female injury mortality were highest in New Mexico (141.1 and 63.7, respectively), and lowest in New York (58.9 and 23.1, respectively). New York also had the lowest injury mortality rate among persons aged ≥65 years (87.1). The states with the highest and lowest lifetime fatal injury costs were California ($20.9 billion) and Vermont ($406 million), respectively. California had the highest number of injury deaths (18,152) and DC the lowest number of injury deaths (385). The lifetime costs per capita for injuries of all intents ranged from $491 to $1,233 (Figure). The five states with the highest lifetime fatal injury costs per capita were New Mexico ($1,233), West Virginia ($1,162), Alaska ($1,091), Louisiana ($1,041), and Oklahoma ($1,040); states with the lowest lifetime costs per capita were New York ($491), New Jersey ($533), California ($538), Massachusetts ($550), and Minnesota ($557).

Unintentional Injuries

West Virginia had the highest lifetime costs per capita for fatal unintentional injuries ($815), the highest unintentional injury mortality rate among males (95.2), and the highest unintentional injury mortality rate among persons aged 25–64 years (88.5) (Table 1). Maryland had the lowest lifetime costs per capita for fatal unintentional injuries ($261), the lowest total unintentional injury mortality rate (26.4), the lowest male unintentional injury mortality rate (36.9), and the lowest unintentional injury mortality rate among persons aged 25–64 years (23.3). New Mexico had the highest total unintentional injury mortality rate (71.9) and the highest female unintentional injury mortality rate (49.9). California had the highest lifetime costs for fatal unintentional injuries ($12.2 billion) and the highest number of unintentional injury deaths (11,804).

Suicides

Alaska and New Jersey had the highest and lowest lifetime suicide costs per capita ($338 and $107, respectively) (Table 2). Montana had the highest total suicide rate (23.8), the highest male suicide rate (36.8), and the highest female suicide rate (11.4). DC had the lowest number of suicides (52), total suicide rate (7.7), male suicide rate (12.3), and lifetime costs ($73 million). California had the highest lifetime costs ($4.9 billion) and the highest number of suicides (4,214).

Homicides

The highest and lowest lifetime homicide-related mortality costs per capita were in DC ($273) and Hawaii ($24), respectively (Table 2). DC had the highest total homicide rate (13.2), the highest male homicide rate (22.3), and the highest female homicide rate (4.8). New Hampshire, Maine, and Massachusetts had the lowest total homicide rate (1.3), the lowest male homicide rate (2.6), and the lowest female homicide rate (0.5), respectively. California had the highest lifetime homicide-related costs ($3.1 billion) and the highest number of homicides (1,813).

Discussion

Economic burdens of fatal injuries varied widely in the 50 states and DC for each of the four categories of intent. Across all the four fatal injury intents, some states consistently had lower lifetime costs per capita than most other states. For example, New York, New Jersey, and California ranked among the five lowest states in terms of lifetime costs per capita for injuries of all intents, unintentional injuries, and suicides. In contrast, New Mexico ranked among the five highest states in terms of lifetime costs per capita for injuries of all intents, unintentional injuries, and suicides. Varying economic burdens of fatal injuries in the 50 states and DC might be attributed to the different injury mortality rates, the different medical costs resulting from different medical procedures, and the different demographic characteristics of injury decedents, such as sex and age.

Implementation of effective injury prevention strategies is needed to help reduce the substantial lifetime medical and work-loss costs associated with fatal injuries. The differing state-level lifetime costs per capita for fatal injuries suggests an urgent need in some states to prevent injuries. States that consistently have lower lifetime costs per capita across different intents of injuries might have successful injury prevention experiences that could be shared with states with higher per capita costs.

The findings in this report are subject to at least four limitations. First, the costs account for medical and work-loss costs associated with decedents. Other societal costs, such as criminal justice costs and the pain and suffering of family members, were not considered. Second, work-loss costs, based on the mean earnings of the general population by sex and specific age groups, might be over- or underestimated because the mean earnings of decedents might differ from those of the general population. Third, intent of fatal injury, as determined from the manner of death assigned on death certificates by coroners or medical examiners, might differ across jurisdictions (5). Finally, unintentional fatal injuries were not broken down into more specific categories such as motor vehicle crashes, drug overdoses, traumatic brain injuries, and older adult falls, so that this report cannot indicate the economic burdens of those specific categories of unintentional injuries.

During 2005–2014, the number of unintentional fatal injuries increased 15%, from 117,809 to 136,053, and unintentional injury moved from the fifth to the fourth leading cause of death; the number of suicides rose 31%, from 32,637 to 42,773, and suicide moved from the eleventh to the tenth leading cause of death (2,6). The increasing incidence and economic burden of injuries, particularly unintentional injuries and suicides, call for effective prevention programs and strategies. For example, the CDC Guideline for Prescribing Opioids for Chronic Pain provides prescribing recommendations for opioid pain medication to patients aged ≥18 years with chronic pain in primary care settings (7), which could be adopted by states and might reduce the number of persons who overdose prescribed opioid medications. To reduce motor vehicle crash fatalities, states could increase seatbelt use with primary enforcement seatbelt laws that cover everyone in the vehicle (8) or consider requiring car seats and booster seats for children through at least age 8 years or until seatbelts fit properly (9). The 2012 Surgeon General’s National Strategy for Suicide Prevention suggests that strategies enhancing social support, community connectedness, and access to mental health and preventive services and measures to reduce stigma and barriers associated with seeking help might alleviate suicide risk across the lifespan (10). The estimates of state-level economic burdens of fatal injuries will permit policy makers to compare the costs of implementing prevention programs and strategies with the cost savings garnered from the aversion of fatal injuries.


Corresponding author: Feijun Luo, fluo@cdc.gov, 770-488-3896.

1Division of Analysis, Research and Practice Integration, National Center for Injury Prevention and Control, CDC.


* All intents category includes legal intervention and undetermined intent of injury, in addition to unintentional, suicide, and homicide.

Lifetime costs or lifetime costs per capita of homicides were not presented for New Hampshire, North Dakota, South Dakota, Vermont, and Wyoming because those states had unstable average medical and work loss costs or unstable homicide rates.

References

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  3. CDC. Web-Based Injury Statistics Query and Reporting System (WISQARS). Atlanta, GA: US Department of Health and Human Services; 2016. https://www.cdc.gov/injury/wisqars
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  10. Office of the Surgeon General. National Action Alliance for Suicide Prevention. 2012 national strategy for suicide prevention: goals and objectives for action. Washington, DC: US Department of Health and Human Services, Office of the Surgeon General; 2012. https://www.surgeongeneral.gov/library/reports/national-strategy-suicide-prevention/full-report.pdf
Return to your place in the textTABLE 1. Deaths from injuries of all intents and unintentional injuries, rates per 100,000 population, lifetime medical and work-loss costs, and lifetime medical and work-loss costs per capita, by state — United States, 2014
State All intents Unintentional injuries
Total Sex Age group (yrs) Total Sex Age group (yrs)
Male Female 0–24 25–64 ≥65 Male Female 0–24 25–64 ≥65
Alabama
No. of deaths (rate) 3,625 (73.2) 2,440 (105.3) 1,185 (44.1) 534 (31.6) 2,224 (89.6) 867 (121.9) 2,463 (49.2) 1,525 (65.9) 938 (34.4) 360 (21.5) 1,396 (55.6) 707 (100.5)
Costs, million USD (per capita, USD*) 4,372 (902) 3,317 1,038 983 3,138 163 2,767 (571) 1,967 784 642 1,943 130
Alaska
No. of deaths (rate) 615 (85.8) 441 (119.9) 174 (50.4) 105 (36.3) 427 (106.1) 83 (141.0) 379 (54.9) 260 (74.2) 119 (35.6) 54 (18.5) 259 (64.7) 66 (116.2)
Costs, million USD (per capita, USD*) 804 (1,091) 634 170 193 592 17 448 (608) 341 109 94a 349 13
Arizona
No. of deaths (rate) 5,079 (72.6) 3,387 (100.4) 1,692 (45.5) 603 (25.1) 2,900 (85.4) 1,575 (152.7) 3,322 (46.8) 2,077 (61.5) 1,245 (32.5) 357 (14.9) 1,710 (50.0) 1,254 (122.9)
Costs, million USD (per capita, USD*) 5,604 (832) 4,326 1,259 1,129 3,942 260 3,226 (479) 2,425 816 652 2,247 201
Arkansas
No. of deaths (rate) 2,280 (75.2) 1,522 (105.7) 758 (46.4) 316 (30.7) 1,330 (89.6) 634 (140.9) 1,458 (47.2) 907 (62.8) 551 (32.6) 189 (18.4) 757 (50.4) 512 (114.8)
Costs, million USD (per capita, USD*) 2,719 (917) 2,052 642 587 1,904 117 1,623 (547) 1,180 420 347 1,080 91
California
No. of deaths (rate) 18,152 (44.9) 12,820 (66.0) 5,332 (25.0) 2,495 (17.6) 11,109 (52.5) 4,544 (90.2) 11,804 (29.1) 7,847 (40.6) 3,957 (18.3) 1,437 (10.2) 6,832 (32.0) 3,531 (69.8)
Costs, million USD (per capita, USD*) 20,894 (538) 16,746 4,209 4,760 14,766 803 12,171 (314) 9,450 2,808 2,686 8,765 601
Colorado
No. of deaths (rate) 3,883 (72.2) 2,543 (98.1) 1,340 (46.9) 471 (25.3) 2,168 (74.5) 1,243 (193.4) 2,517 (47.1) 1,513 (60.1) 1,004 (34.4) 254 (13.6) 1,221 (41.7) 1,042 (163.2)
Costs, million USD (per capita, USD*) 4,175 (779) 3,202 989 873 2,915 194 2,317 (433) 1,691 640 459 1,602 154
Connecticut
No. of deaths (rate) 2,140 (53.9) 1,373 (76.7) 767 (33.0) 205 (16.6) 1,152 (60.8) 783 (129.5) 1,642 (40.8) 1,005 (56.8) 637 (26.4) 120 (9.7) 824 (44.2) 698 (114.1)
Costs, million USD (per capita, USD*) 2,186 (608) 1,682 464 405 1,584 117 1,446 (402) 1,100 330 234 1,126 100
Delaware
No. of deaths (rate) 629 (65.8) 433 (97.0) 196 (37.4) 79 (25.0) 383 (81.5) 167 (114.8) 425 (43.9) 270 (60.2) 155 (29.1) 50 (15.8) 239 (50.6) 136 (94.8)
Costs, million USD (per capita, USD*) 775 (829) 592 184 146 549 31 472 (505) 334 139 88 338 24
District of Columbia
No. of deaths (rate) 385 (56.2) 264 (81.7) 121 (33.7) 50 (19.8) 250 (67.6) 85 (111.1) 217 (32.7) 130 (42.4) 87 (24.0) 12 (4.8§) 133 (36.8) 72 (94.0)
Costs, million USD (per capita, USD*) 479 (726) 370 97 97 357 13 194 (294) 130 61 163 11
Florida
No. of deaths (rate) 13,673 (61.5) 9,216 (88.4) 4,457 (35.8) 1,672 (26.7) 7,363 (71) 4,636 (119.5) 9,433 (41.2) 5,932 (56.2) 3,501 (27) 1,025 (16.5) 4,610 (44.3) 3,796 (97.5)
Costs, million USD (per capita, USD*) 14,763 (742) 11,411 3,326 3,111 9,992 773 9,478 (476) 7,055 2,386 1,859 6,301 608
Georgia
No. of deaths (rate) 6,002 (60.1) 4,061 (85.8) 1,941 (36.5) 946 (25.8) 3,589 (66.8) 1,467 (128.1) 3,964 (40.1) 2,491 (53.8) 1,473 (27.6) 561 (15.4) 2,197 (40.6) 1,206 (106.9)
Costs, million USD (per capita, USD*) 7,055 (699) 5,452 1,582 1,755 4,910 271 4,232 (419) 3,117 1,104 1,009 2,927 214
Hawaii
No. of deaths (rate) 733 (47.3) 527 (70.6) 206 (24.0) 79 (16.1) 428 (57.5) 226 (92.5) 476 (29.9) 327 (43.9) 149 (16.3) 47 (9.6) 246 (32.9) 183 (73.8)
Costs, million USD (per capita, USD*) 825 (581) 684 148 149 588 39 482 (340) 389 86 86 340 30
Idaho
No. of deaths (rate) 1,156 (71.2) 742 (95.2) 414 (48.4) 172 (29.4) 607 (75.0) 377 (172.7) 765 (46.5) 457 (58.8) 308 (35.0) 100 (17.1) 341 (41.6) 324 (149.2)
Costs, million USD (per capita, USD*) 1,274 (780) 916 350 311 814 63 785 (480) 547 238 177 458 52
Illinois
No. of deaths (rate) 6,983 (52.0) 4,808 (75.9) 2,175 (29.6) 1,123 (25.0) 4,006 (58.3) 1,853 (101.7) 4,644 (34.2) 2,918 (46.5) 1,726 (22.9) 557 (12.4) 2,506 (36.3) 1,581 (86.5)
Costs, million USD (per capita, USD*) 8,297 (644) 6,550 1,697 2,104 5,759 311 4,833 (375) 3,579 1,206 1,015 3,502 256
Indiana
No. of deaths (rate) 4,462 (66.5) 3,007 (94.1) 1,455 (40.1) 687 (29.0) 2,685 (79.9) 1,088 (115.6) 2,974 (43.8) 1,853 (58.3) 1,121 (30.0) 390 (16.6) 1,665 (49.2) 919 (97.3)
Costs, million USD (per capita, USD*) 5,240 (794) 4,059 1,190 1,288 3,718 196 3,166 (480) 2,339 823 716 2,279 160
Iowa
No. of deaths (rate) 2,045 (58.4) 1,300 (81.2) 745 (37.4) 237 (21.5) 936 (58.4) 872 (161.7) 1,517 (41.9) 898 (55.8) 619 (29.3) 135 (12.4) 586 (36.3) 796 (146.9)
Costs, million USD (per capita, USD*) 1,987 (639) 1,493 479 435 1,242 140 1,292 (416) 937 343 243 756 123
Kansas
No. of deaths (rate) 1,987 (65.2) 1,292 (89.8) 695 (41.7) 266 (24.7) 1,046 (71.2) 675 (154) 1,377 (44.1) 829 (57.4) 548 (31.5) 157 (14.6) 634 (42.7) 586 (132.3)
Costs, million USD (per capita, USD*) 2,223 (765) 1,697 505 491 1,438 115 1,367 (471) 1,004 339 284 855 97
Kentucky
No. of deaths (rate) 3,634 (80.7) 2,466 (114.5) 1,168 (48.8) 427 (27.8) 2,343 (102.7) 864 (138.4) 2,622 (58.3) 1,677 (78.8) 945 (39.1) 296 (19.3) 1,616 (71) 710 (114.9)
Costs, million USD (per capita, USD*) 4,296 (973) 3,300 1,010 767 3,314 164 2,966 (672) 2,196 775 523 2,293 131
Louisiana
No. of deaths (rate) 3,654 (77.5) 2,576 (113.8) 1,078 (43.7) 659 (39.6) 2,334 (95.9) 659 (107.8) 2,344 (49.6) 1,584 (70.5) 760 (30.4) 381 (22.9) 1,440 (58.9) 522 (86.1)
Costs, million USD (per capita, USD*) 4,839 (1,041) 3,805 1,008 1,233 3,430 127 2,855 (614) 2,203 666 685 2,045 97
Maine
No. of deaths (rate) 952 (65.0) 633 (93.4) 319 (38.5) 105 (26.5) 492 (71.3) 354 (146.8) 690 (45.9) 429 (63.1) 261 (30.0) 63 (15.9) 320 (46.7) 306 (126.7)
Costs, million USD (per capita, USD*) 960 (722) 736 215 200a 649 60 626 (470) 467 152 117 423 50
Maryland
No. of deaths (rate) 3,482 (56.1) 2,426 (83.7) 1,056 (31.0) 462 (22.6) 2,129 (65.9) 891 (109.3) 1,674 (26.4) 1,046 (36.9) 628 (17.3) 183 (9) 772 (23.3) 719 (88.3)
Costs, million USD (per capita, USD*) 4,233 (708) 3,376 838 888 3,049 149 1,560 (261) 1,183 363 340 1,039 114
Massachusetts
No. of deaths (rate) 3,452 (47.4) 2,361 (70.4) 1,091 (26.4) 335 (13.8) 2,132 (59.4) 984 (92.1) 2,692 (36.8) 1,767 (53.2) 925 (21.9) 230 (9.4) 1,577 (44.3) 884 (82.4)
Costs, million USD (per capita, USD*) 3,707 (550) 3,032 711 648 2,936 158 2,508 (372) 2,059 503 444 2,143 138
Michigan
No. of deaths (rate) 6,652 (63.8) 4,392 (89.2) 2,260 (39.9) 967 (27.6) 3,807 (74.2) 1,878 (122.5) 4,422 (41.5) 2,714 (55.0) 1,708 (28.9) 532 (15.4) 2,283 (43.9) 1,607 (104.6)
Costs, million USD (per capita, USD*) 7,539 (761) 5,766 1,749 1,780 5,194 322 4,338 (438) 3,168 1,172 943 3,014 264
Minnesota
No. of deaths (rate) 3,226 (54.3) 1,956 (71.6) 1,270 (37.4) 361 (19.6) 1,465 (50.0) 1,400 (168.8) 2,385 (39.2) 1,327 (49.0) 1,058 (29.8) 197 (10.7) 888 (30.3) 1,300 (155.9)
Costs, million USD (per capita, USD*) 3,041 (557) 2,227 771 670 1,953 210 1,855 (340) 1,296 526 358 1,137 190
Mississippi
No. of deaths (rate) 2,477 (81.8) 1,702 (120.0) 775 (47.4) 443 (40.7) 1,421 (93.4) 612 (149) 1,712 (56.2) 1,085 (77.0) 627 (37.8) 288 (26.9) 903 (58.7) 520 (127.4)
Costs, million USD (per capita, USD*) 2,872 (959) 2,306 601 807 1,963 110 1,816 (607) 1,379 447 512 1,215 92
Missouri
No. of deaths (rate) 4,672 (74.1) 3,142 (105.9) 1,530 (43.9) 675 (32.2) 2,658 (85.7) 1,339 (143.6) 3,110 (48.5) 1,911 (64.3) 1,199 (33.4) 407 (19.6) 1,585 (50.9) 1,118 (119.7)
Costs, million USD (per capita, USD*) 5,371 (886) 4,213 1,159 1,249 3,767 230 3,203 (528) 2,379 830 731 2,185 186
Montana
No. of deaths (rate) 902 (83.1) 586 (110.5) 316 (56.2) 121 (34.9) 475 (91.4) 306 (183.8) 581 (52.6) 343 (64.8) 238 (40.5) 75 (21.8) 253 (49.1) 253 (153.3)
Costs, million USD (per capita, USD*) 973 (950) 729 239 219 653 55 579 (566) 411 160 133 359 44
Nebraska
No. of deaths (rate) 1,116 (56.0) 752 (80.6) 364 (32.9) 161 (23.7) 563 (58.9) 392 (134.7) 781 (38.2) 492 (52.8) 289 (24.7) 95 (13.9) 338 (35.1) 348 (118.5)
Costs, million USD (per capita, USD*) 1,139 (605) 913 245 296 754 61 697 (370) 543 169 172 446 52
Nevada
No. of deaths (rate) 1,948 (67.0) 1,359 (94.6) 589 (39.7) 251 (26.6) 1251 (81.2) 446 (121.7) 1,166 (40.1) 750 (52.1) 416 (28.1) 144 (15.3) 722 (46.4) 300 (83.6)
Costs, million USD (per capita, USD*) 2,294 (808) 1,781 534 464 1,665 85 1,319 (465) 975 359 265 949 54
New Hampshire
No. of deaths (rate) 1,001 (70.8) 645 (97.9) 356 (44.6) 92 (20.1) 584 (84.9) 325 (154.8) 716 (50.4) 435 (67.2) 281 (34.2) 56 (12.1) 376 (55.7) 284 (135.6)
Costs, million USD (per capita, USD*) 1,022 (771) 800 226 174 798 55 664 (500) 515 156 104 522 46
New Jersey
No. of deaths (rate) 4,210 (44.4) 2,881 (65.2) 1,329 (25.4) 555 (18.8) 2,454 (51.1) 1,200 (88.4) 2,970 (30.8) 1,935 (43.9) 1,035 (19.1) 319 (10.8) 1,597 (33.1) 1,053 (77.2)
Costs, million USD (per capita, USD*) 4,765 (533) 3,806 961 1,074 3,465 201 2,991 (335) 2,368 657 607 2,238 171
New Mexico
No. of deaths (rate) 2,163 (101.9) 1,443 (141.1) 720 (63.7) 291 (38.5) 1,303 (124.7) 569 (185.9) 1,534 (71.9) 958 (94.3) 576 (49.9) 173 (22.8) 899 (85.7) 462 (152.4)
Costs, million USD (per capita, USD*) 2,573 (1,233) 1,965 603 542 1,844 101 1,659 (796) 1,214 445 315 1,250 79
New York
No. of deaths (rate) 8,585 (40.2) 5,801 (58.9) 2,784 (23.1) 1,046 (15.1) 4,934 (45.9) 2,600 (87.1) 5,945 (27.5) 3,799 (38.8) 2,146 (17.2) 587 (8.5) 3,095 (28.7) 2,259 (75.5)
Costs, million USD (per capita, USD*) 9,689 (491) 7,594 1,987 1,987 6,858 436 5,772 (292) 4,443 1,302 1,095 4,158 363
North Carolina
No. of deaths (rate) 6,541 (63.7) 4,358 (90.8) 2,183 (39.2) 890 (25.6) 3,709 (71.0) 1,940 (140.2) 4,558 (44.3) 2,881 (60.9) 1,677 (29.5) 552 (16.0) 2,378 (45.4) 1,626 (118.7)
Costs, million USD (per capita, USD*) 7,310 (735) 5,674 1,607 1,681 5,148 334 4,620 (465) 3,517 1,093 1,021 3,255 270
North Dakota
No. of deaths (rate) 514 (64.1) 353 (89.5) 161 (38.6) 82 (27.0) 258 (68.6) 174 (149.1) 349 (42.8) 219 (56.8) 130 (29.4) 44 (14.6) 146 (39.3) 159 (135.8)
Costs, million USD (per capita, USD*) 545 (737) 447 100 158 367 30 312 (422) 245 69 82 205 26
Ohio
No. of deaths (rate) 8,366 (69.4) 5,541 (97.9) 2,825 (42.9) 984 (24.8) 5,062 (85.5) 2,320 (128.0) 6,178 (50.6) 3,828 (68.0) 2,350 (34.6) 576 (14.5) 3,595 (60.6) 2,007 (110.6)
Costs, million USD (per capita, USD*) 9,370 (808) 7,217 2,143 1,820 7,038 403 6,200 (535) 4,607 1,609 1,041 4,874 338
Oklahoma
No. of deaths (rate) 3,522 (88.8) 2,277 (119.9) 1,245 (59.6) 485 (34.6) 2,069 (104.3) 968 (176.8) 2,421 (60.3) 1,465 (77.3) 956 (44.5) 283 (20.3) 1,308 (65.0) 830 (152.5)
Costs, million USD (per capita, USD*) 4,035 (1,040) 3,024 981 893 2,841 171 2,508 (647) 1,812 686 511 1,747 141
Oregon
No. of deaths (rate) 2,773 (64.1) 1,805 (88.6) 968 (40.8) 286 (22.1) 1,477 (69.0) 1,010 (161.8) 1,803 (40.8) 1,072 (52.7) 731 (29.5) 156 (12.1) 826 (38.3) 821 (131.8)
Costs, million USD (per capita, USD*) 2,704 (681) 2,075 624 530 1,932 159 1,504 (379) 1,111 383 285 1,068 122
Pennsylvania
No. of deaths (rate) 9,224 (66.1) 6,111 (94.1) 3,113 (40.0) 1,102 (25.4) 5,245 (78.8) 2,875 (127.4) 6,640 (46.6) 4,091 (63.0) 2,549 (31.5) 683 (15.8) 3,454 (52.1) 2,503 (109.7)
Costs, million USD (per capita, USD*) 10,089 (789) 7,874 2,229 2,085 7,225 477 6,420 (502) 4,820 1,633 1,256 4,687 404
Rhode Island
No. of deaths (rate) 748 (62.8) 475 (88.8) 273 (40.0) 59 (15.2) 422 (75.6) 267 (143.4) 592 (49.0) 360 (67.9) 232 (32.7) 33 (8.6) 316 (57.0) 243 (129.3)
Costs, million USD (per capita, USD*) 771 (731) 576 179 113 578 41 526 (498) 387 134 62 420 36
South Carolina
No. of deaths (rate) 3,608 (72.0) 2,422 (103.1) 1,186 (44.0) 564 (33.8) 2,111 (83.4) 933 (132.2) 2,436 (48.2) 1,519 (65.0) 917 (33.4) 334 (20.3) 1,333 (52.1) 769 (110.0)
Costs, million USD (per capita, USD*) 4,279 (885) 3,309 962 1,054 2,925 169 2,693 (557) 1,984 695 615 1,821 136
South Dakota
No. of deaths (rate) 642 (71.1) 415 (97.4) 227 (45.9) 110 (35.9) 320 (75.8) 212 (149.9) 462 (49.2) 282 (65.6) 180 (34.3) 67 (22.1) 195 (45.6) 200 (139.9)
Costs, million USD (per capita, USD*) 687 (805) 505 172 197 448 35 422 (495) 302 111 119 270 31
Tennessee
No. of deaths (rate) 5,237 (77.4) 3,489 (110.5) 1,748 (47.2) 631 (27.9) 3,093 (90.2) 1,512 (163.1) 3,781 (55.5) 2,361 (75.3) 1,420 (37.6) 361 (16.0) 2,116 (61.4) 1,304 (141.7)
Costs, million USD (per capita, USD*) 5,947 (908) 4,556 1,396 1,162 4,262 273 3,900 (595) 2,871 1,030 650 2,843 228
Texas
No. of deaths (rate) 14,652 (55.6) 10,164 (79.8) 4,488 (32.8) 2,454 (24.4) 8,777 (62.2) 3,419 (115.9) 9,723 (37.2) 6,398 (51.2) 3,325 (24.2) 1,498 (14.9) 5,434 (38.3) 2,789 (95.4)
Costs, million USD (per capita, USD*) 17,522 (650) 13,869 3,740 4,549 12,340 615 10,648 (395) 8,237 2,512 2,720 7,485 486
Utah
No. of deaths (rate) 1,924 (73.0) 1,265 (97.1) 659 (49.7) 286 (23.5) 1,190 (85.7) 446 (158.9) 1,167 (45.3) 726 (57.5) 441 (33.5) 141 (11.5) 662 (47.6) 364 (130.0)
Costs, million USD (per capita, USD*) 2,362 (803) 1,794 564 525 1,726 78 1,251 (425) 937 315 250 942 61
Vermont
No. of deaths (rate) 478 (68.2) 291 (91.0) 187 (45.4) 54 (24.6) 208 (64.2) 216 (207.0) 322 (44.4) 168 (53.3) 154 (34.9) 25 (10.9) 112 (34.5) 185 (179.2)
Costs, million USD (per capita, USD*) 406 (648) 314 88 102 265 32 228 (365) 161 62 46 140 27
Virginia
No. of deaths (rate) 4,701 (54.7) 3,141 (77.2) 1,560 (33.7) 634 (21.9) 2,618 (57.9) 1,449 (132.9) 3,147 (36.7) 1,962 (49.2) 1,185 (25.2) 362 (12.5) 1,577 (34.9) 1,208 (111.6)
Costs, million USD (per capita, USD*) 5,166 (620) 3,996 1,128 1,196 3,655 244 3,004 (361) 2,265 720 671 2,163 194
Washington
No. of deaths (rate) 4,428 (59.6) 2,909 (81.9) 1,519 (38.2) 530 (22.0) 2,446 (63.3) 1,451 (149.5) 2,997 (39.9) 1,821 (51.8) 1,176 (28.8) 304 (12.6) 1,451 (37.0) 1,242 (128.6)
Costs, million USD (per capita, USD*) 4,600 (651) 3,550 1,052 1,004 3,262 240 2,727 (386) 2,020 708 564 1,873 197
West Virginia
No. of deaths (rate) 1,897 (98.0) 1,253 (134.8) 644 (62.6) 201 (33.9) 1,170 (125.0) 526 (166.2) 1,380 (71.1) 874 (95.2) 506 (47.9) 122 (20.6) 818 (88.5) 440 (140.5)
Costs, million USD (per capita, USD*) 2,149 (1,162) 1,599 530 369 1,618 94 1,507 (815) 1,099 393 225 1,133 77
Wisconsin
No. of deaths (rate) 4,032 (64.2) 2,463 (85.0) 1,569 (43.7) 480 (24.1) 1,965 (64.8) 1,587 (174.2) 3,015 (46.7) 1,696 (58.4) 1,319 (35.1) 275 (13.8) 1,279 (41.6) 1,461 (159.6)
Costs, million USD (per capita, USD*) 3,934 (683) 2,895 967 906 2,617 229 2,499 (434) 1,765 700 508 1,665 203
Wyoming
No. of deaths (rate) 514 (86.6) 355 (119.2) 159 (52.2) 81 (39.6) 322 (105.3) 111 (141.4) 361 (60.2) 234 (78.4) 127 (40.8) 46 (22.3) 225 (72.4) 90 (116.0)
Costs, million USD (per capita, USD*) 581 (995) 454 134 149 415 21 384 (658) 286 103 83 291 17

* Costs per capita calculated only for totals.
Average medical cost was statistically unstable; however, it accounted for less than 1% of combined average cost.
§ Rates based on ≤20 deaths might be unstable.
Both average medical cost and average work loss cost were statistically unstable.

Return to your place in the textTABLE 2. Suicide and homicide deaths, rates per 100,000 population, lifetime medical and work-loss costs, and lifetime medical and work-loss costs per capita, by state — United States, 2014
State Suicides Homicides
Total Sex Total Sex
Male Female Male Female
Alabama
No. deaths (rate) 715 (14.5) 569 (24.3) 146 (5.6) 374 (8.0) 304 (13.4) 70 (2.8)
Costs, million USD (per capita, USD*) 897 (185) 755 143 606 (125) 532 76
Alaska
No. deaths (rate) 167 (22.0) 138 (34.8) 29 (7.9) 37 (4.7) 22 (5.3) 15 (4.1)
Costs, million USD (per capita, USD*) 249 (338) 220 32 61 (83) 38 —**
Arizona
No. deaths (rate) 1,244 (18.0) 945 (27.7) 299 (8.7) 322 (5.0) 249 (7.7) 73 (2.2)
Costs, million USD (per capita, USD*) 1,528 (227) 1,222 293 538 (80) 448 82
Arkansas
No. deaths (rate) 515 (17.2) 406 (27.9) 109 (7.2) 217 (7.6) 158 (11.3) 59 (4.1)
Costs, million USD (per capita, USD*) 671 (226) 550 119 323 (109) 258 62
California
No. deaths (rate) 4,214 (10.5) 3,234 (16.7) 980 (4.7) 1,813 (4.6) 1,514 (7.6) 299 (1.5)
Costs, million USD (per capita, USD*) 4,927 (127) 3,986 933 3,103 (80) 2,794 337
Colorado
No. deaths (rate) 1,083 (19.8) 843 (31.3) 240 (8.7) 177 (3.3) 124 (4.5) 53 (2.1)
Costs, million USD (per capita, USD*) 1,421 (265) 1,174 252 282 (53) 215 58
Connecticut
No. deaths (rate) 379 (9.7) 276 (14.8) 103 (5.1) 99 (2.8) 75 (4.3) 24 (1.3)
Costs, million USD (per capita, USD*) 475 (132) 368 98 170 (47) 142 25
Delaware
No. deaths (rate) 126 (13.2) 100 (22.3) 26 (5.3) 57 (6.5) 47 (10.9) 10 (2.2)
Costs, million USD (per capita, USD*) 168 (179) 140 —** 98 (105) 87 —**
District of Columbia
No. deaths (rate) 52 (7.7) 39 (12.3) 13 (4.0) 97 (13.2) 79 (22.3) 18 (4.8)
Costs, million USD (per capita, USD*) 73 (110) 59 —** 180 (273) 152 —**
Florida
No. deaths (rate) 3,035 (13.8) 2,328 (21.9) 707 (6.3) 1,158 (6.2) 915 (9.8) 243 (2.5)
Costs, million USD (per capita, USD*) 3,332 (167) 2,701 624 1,852 (93) 1,584 282
Georgia
No. deaths (rate) 1,294 (12.6) 998 (20.6) 296 (5.6) 658 (6.5) 518 (10.2) 140 (2.8)
Costs, million USD (per capita, USD*) 1,622 (161) 1,323 292 1,087 (108) 933 155
Hawaii
No. deaths (rate) 204 (13.6) 163 (21.5) 41 (5.4) 30 (2.3) 21 (3.0) ††
Costs, million USD (per capita, USD*) 283 (199) 243 43 34§ (24) —** —**
Idaho
No. deaths (rate) 320 (20.1) 240 (30.5) 80 (10.1) 36 (2.4) 22 (3.0) 14 (1.7)
Costs, million USD (per capita, USD*) 391 (239) 299 89 49§ (30) —** —**
Illinois
No. deaths (rate) 1,398 (10.4) 1,110 (17.1) 288 (4.2) 792 (6.2) 679 (10.6) 113 (1.8)
Costs, million USD (per capita, USD*) 1,780 (138) 1,474 304 1,409 (109) 1,307 123
Indiana
No. deaths (rate) 948 (14.3) 756 (23.4) 192 (5.6) 364 (5.7) 290 (9.0) 74 (2.3)
Costs, million USD (per capita, USD*) 1,210 (183) 1,023 194 597 (90) 515 86
Iowa
No. deaths (rate) 407 (12.8) 327 (20.7) 80 (5.2) 78 (2.5) 50 (3.2) 28 (1.8)
Costs, million USD (per capita, USD*) 520 (167) 437 81 114 (37) 87 32§
Kansas
No. deaths (rate) 455 (15.7) 356 (25.0) 99 (6.6) 104 (3.6) 75 (5.2) 29 (2.1)
Costs, million USD (per capita, USD*) 624 (215) 511 111 168 (58) 132 34
Kentucky
No. deaths (rate) 727 (15.9) 582 (26.2) 145 (6.2) 203 (4.7) 153 (7.1) 50 (2.3)
Costs, million USD (per capita, USD*) 927 (210) 771 151 303 (69) 253 55
Louisiana
No. deaths (rate) 679 (14.3) 506 (22.2) 173 (7.0) 538 (11.6) 428 (18.6) 110 (4.7)
Costs, million USD (per capita, USD*) 888 (191) 692 176 941 (202) 796 135
Maine
No. deaths (rate) 220 (15.7) 174 (25.5) 46 (6.7) 23 (2.0) 15 (2.6) ††
Costs, million USD (per capita, USD*) 269 (202) 219 49 35§ (26) —** —**
Maryland
No. deaths (rate) 606 (9.8) 470 (16.1) 136 (4.2) 387 (6.6) 312 (10.8) 75 (2.4)
Costs, million USD (per capita, USD*) 763 (128) 617 140 692 (116) 593 91
Massachusetts
No. deaths (rate) 596 (8.3) 472 (13.6) 124 (3.4) 110 (1.6) 91 (2.7) 19 (0.5)
Costs, million USD (per capita, USD*) 782 (116) 657 126 197 (29) 176 24
Michigan
No. deaths (rate) 1,354 (13.2) 1,062 (21.3) 292 (5.6) 589 (6.2) 465 (9.8) 124 (2.6)
Costs, million USD (per capita, USD*) 1,735 (175) 1,461 276 990 (100) 831 149
Minnesota
No. deaths (rate) 686 (12.2) 525 (18.8) 161 (5.9) 101 (1.9) 69 (2.6) 32 (1.2)
Costs, million USD (per capita, USD*) 914 (168) 741 172 170 (31) 125 40
Mississippi
No. deaths (rate) 380 (12.5) 299 (20.8) 81 (5.3) 332 (11.3) 277 (19.4) 55 (3.5)
Costs, million USD (per capita, USD*) 481 (161) 406 74 530 (177) 484 62
Missouri
No. deaths (rate) 1,017 (16.3) 817 (27.2) 200 (6.3) 441 (7.5) 357 (12.3) 84 (2.8)
Costs, million USD (per capita, USD*) 1,302 (215) 1,091 205 745 (123) 650 94
Montana
No. deaths (rate) 251 (23.8) 197 (36.8) 54 (11.4) 30 (2.9) 23 (4.4) ††
Costs, million USD (per capita, USD*) 302 (295) 250 52 40 (39) —** —**
Nebraska
No. deaths (rate) 251 (13.4) 202 (21.7) 49 (5.4) 63 (3.4) 47 (5.0) 16 (1.7)
Costs, million USD (per capita, USD*) 313 (166) 263 51 108 (58) 91 —**
Nevada
No. deaths (rate) 573 (19.5) 449 (31.2) 124 (8.2) 176 (6.3) 138 (9.8) 38 (2.7)
Costs, million USD (per capita, USD*) 669 (236) 547 124 266 (94) 235 41§
New Hampshire
No. deaths (rate) 247 (17.6) 191 (27.5) 56 (8.1) 17 (1.3) †† ††
Costs, million USD (per capita, USD*) 302 (228) 251 49 —** —** —**
New Jersey
No. deaths (rate) 786 (8.3) 590 (12.9) 196 (4.1) 372 (4.4) 302 (7.2) 70 (1.6)
Costs, million USD (per capita, USD*) 958 (107) 748 203 654 (73) 568 80
New Mexico
No. deaths (rate) 449 (21.0) 350 (33.4) 99 (9.2) 135 (6.8) 106 (10.5) 29 (2.9)
Costs, million USD (per capita, USD*) 594 (285) 501 98 218 (105) 183 32§
New York
No. deaths (rate) 1,700 (8.1) 1,262 (12.5) 438 (4.0) 662 (3.3) 536 (5.5) 126 (1.2)
Costs, million USD (per capita, USD*) 2,139 (108) 1,674 435 1,157 (59) 1,010 147
North Carolina
No. deaths (rate) 1,351 (13.0) 984 (19.8) 367 (6.9) 551 (5.6) 435 (8.9) 116 (2.3)
Costs, million USD (per capita, USD*) 1,685 (169) 1,296 369 730 (73) 769 128
North Dakota
No. deaths (rate) 137 (17.5) 113 (27.8) 24 (6.7) 15 (2.0) 13 (3.0) ††
Costs, million USD (per capita, USD*) 195 (264) 169 —** —** —** —**
Ohio
No. deaths (rate) 1,491 (12.6) 1,163 (20.1) 328 (5.7) 578 (5.2) 472 (8.4) 106 (1.9)
Costs, million USD (per capita, USD*) 1,939 (167) 1,588 344 955 (82) 843 122
Oklahoma
No. deaths (rate) 736 (19.1) 561 (29.5) 175 (9.2) 250 (6.5) 183 (9.5) 67 (3.5)
Costs, million USD (per capita, USD*) 999 (258) 801 186 409 (105) 316 83
Oregon
No. deaths (rate) 782 (18.7) 614 (30.1) 168 (7.9) 99 (2.4) 65 (3.1) 34 (1.7)
Costs, million USD (per capita, USD*) 911 (229) 755 157 131 (33) 104 33
Pennsylvania
No. deaths (rate) 1,817 (13.3) 1,440 (21.6) 377 (5.6) 620 (5.1) 492 (8.1) 128 (2.0)
Costs, million USD (per capita, USD*) 2,307 (180) 1,928 378 1,059 (83) 901 149
Rhode Island
No. deaths (rate) 113 (10.0) 82 (14.9) 31 (5.4) 27 (2.5) 23 (4.2) ††
Costs, million USD (per capita, USD*) 159 (151) 120 —** 45 (43) —** —**
South Carolina
No. deaths (rate) 753 (15.1) 579 (24.4) 174 (6.8) 363 (7.5) 286 (12.1) 77 (3.1)
Costs, million USD (per capita, USD*) 953 (197) 785 170 587 (121) 503 84
South Dakota
No. deaths (rate) 141 (17.0) 109 (25.9) 32 (7.9) 26 (3.2) 15 (3.6) 11 (2.7)
Costs, million USD (per capita, USD*) 197 (231) 162 37 —** —** —**
Tennessee
No. deaths (rate) 948 (14.1) 746 (23.3) 202 (5.8) 379 (5.9) 309 (9.6) 70 (2.2)
Costs, million USD (per capita, USD*) 1,241 (189) 1,032 214 595 (91) 523 82
Texas
No. deaths (rate) 3,254 (12.2) 2,528 (19.5) 726 (5.4) 1,389 (5.1) 1,059 (7.8) 330 (2.5)
Costs, million USD (per capita, USD*) 4,264 (158) 3,490 754 2,240 (83) 1,867 386
Utah
No. deaths (rate) 559 (20.6) 418 (31.0) 141 (10.5) 61 (2.1) 39 (2.7) 22 (1.4)
Costs, million USD (per capita, USD*) 802 (273) 634 158 89 (30) 67 25
Vermont
No. deaths (rate) 124 (18.6) 102 (30.7) 22 (7.2) 16 (2.9) 13 (4.8) ††
Costs, million USD (per capita, USD*) 148 (237) 131 —** —** —** —**
Virginia
No. deaths (rate) 1,122 (12.9) 870 (20.7) 252 (5.7) 339 (4.1) 249 (5.9) 90 (2.2)
Costs, million USD (per capita, USD*) 1,412 (170) 1,150 252 555 (67) 449 105
Washington
No. deaths (rate) 1,119 (15.2) 854 (23.5) 265 (7.2) 211 (3.0) 157 (4.4) 54 (1.6)
Costs, million USD (per capita, USD*) 1,404 (199) 1,147 253 333 (47) 272 63
West Virginia
No. deaths (rate) 359 (18.1) 280 (28.6) 79 (8.1) 103 (5.9) 70 (7.9) 33 (3.9)
Costs, million USD (per capita, USD*) 426 (230) 346 71 156 (85) 113 41
Wisconsin
No. deaths (rate) 769 (13.1) 598 (20.6) 171 (5.9) 166 (3.0) 126 (4.5) 40 (1.4)
Costs, million USD (per capita, USD*) 981 (170) 806 170 274 (48) 227 45
Wyoming
No. deaths (rate) 120 (20.7) 96 (32.3) 24 (8.7) 24 (4.4) 16 (5.8) ††
Costs, million USD (per capita, USD*) 153 (262) 131 21 —** —** —**

* Costs per capita calculated only for totals.
Average medical cost was statistically unstable; however, it accounted for less than 1% of combined average cost.
§ Average medical cost was statistically unstable; however, it accounted for less than 5% of combined average cost.
Rates based on ≤20 deaths might be unstable.
** Both average medical cost and average work loss cost were statistically unstable.
†† State-level counts and rates based on <10 deaths have been suppressed.

Return to your place in the textFIGURE. Costs per capita* of fatal injuries of all intents — United States, 2014
The figure above is a map of the United States showing the costs per capita of fatal injuries of all intents in the U.S. during 2014.

* In 2014 U.S. dollars.

Suggested citation for this article: Luo F, Florence C. State-Level Lifetime Medical and Work-Loss Costs of Fatal Injuries — United States, 2014. MMWR Morb Mortal Wkly Rep 2017;66:1–11. DOI: http://dx.doi.org/10.15585/mmwr.mm6601a1.

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