Abstract
IMPORTANCE: Trauma care, with its inherent complexity and unpredictability, substantially contributes to health care costs in the US. Understanding temporal trends and associated factors may inform targeted cost-mitigation strategies. OBJECTIVE: To examine trends in trauma-related inpatient costs from 2012 to 2021 and identify patient and hospital factors associated with contemporary costs. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from the 2012-2021 National Inpatient Sample, which captures 97% of US hospitalizations. Hospitalization for traumatic injuries were identified using International Classification of Diseases, Ninth Revision and International Statistical Classification of Disease, Tenth Revision codes for external causes of injury. The data analysis was performed between September 2 and October 28, 2024. EXPOSURE: External causes of traumatic injury. MAIN OUTCOMES AND MEASURES: The primary outcome was temporal trends in annual and per-patient hospitalization costs. Additionally, risk-adjusted associations of patient and hospital characteristics with inpatient costs in 2021 were assessed. RESULTS: A total of 18 353 296 hospitalizations were identified during the study period (median [IQR] patient age ranging from 69 [47-83] years in 2012 to 70 [52-82] years in 2021; proportion of women ranging from 53.2% in 2012 to 50.7% in 2021). When stratifying by mechanism of injury, motor vehicle collisions incurred the highest median inpatient costs ($15 412; IQR, $8718-$29 376), followed by falls ($11 769; IQR, $6930-$19 052), other blunt trauma ($9818; IQR, $5567-$17 488), and penetrating injury ($9669; IQR, $4948-$19 545). In 2021, falls accounted for the largest share of costs (70.0%), while patients aged 75 years or older represented the most costly group (34.8%) and Medicare incurred the highest costs among all payers (52.6%). Annual inpatient trauma care costs increased from $27 billion in 2012 to $42 billion in 2021. Median per-patient costs rose from $10 662 (IQR, $6141-$17930) to $14 124 (IQR, $8249-$23 491). Following risk adjustment (2021), motor vehicle collisions (β = $4735.80; 95% CI, $4337.19-$5134.41 [reference, falls]), Black race (β = $1134.86; 95% CI, $628.07-$1641.67 [reference, White race]), and care in the Pacific region (β = $7763.20; 95% CI, $6176.90-$9350.31 [reference, New England]) were associated with greater hospitalization costs. CONCLUSIONS AND RELEVANCE: This cohort study found that inpatient trauma costs nearly doubled between 2012 and 2021, with geriatric falls a major contributor. Geographic and demographic disparities underscore the need for targeted interventions. Addressing systemic inefficiencies and standardizing care practices are critical to curbing rising costs while ensuring equitable trauma care.