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Press release

New research documents the rising economic burden of US firearm injuries and deaths

Ann Arbor | November 27, 2023

An in-depth analysis of costs associated with US fatal and nonfatal firearm injuries conducted by investigators at CDC and reported in the American Journal of Preventive Medicine reveals a 16% increase in 2020 compared with 2019

The economic impact of fatal and nonfatal firearm injuries in the United States increased by 16% in 2020 compared with 2019, according to new researchopens in new tab/window reported in the American Journal of Preventive Medicineopens in new tab/window, published by Elsevier. The study also provides evidence of significant disparities in costs associated with firearm deaths in 2019−2020, with non-Hispanic Black individuals, males, and young and middle-aged groups being most affected, along with those who reside in urban areas and the South.

Firearm-related injuries are among the five leading causes of death for people one to 44 years of age in the United States. These fatal and nonfatal injuries take a human toll on individuals, families, and communities—and come at a high economic cost to the nation.

Investigators at the US Centers for Disease Control and Prevention (CDC) analyzed data from the following data sources to provide estimates of the economic burden of fatal and nonfatal firearm injuries in the United States in 2020: 2019−2020 Healthcare Cost and Utilization Project (HCUP) Nationwide Emergency Department Sample (NEDS) database, the most recent data available; and the 2019−2020 multiple cause-of-death mortality data from the restricted-use National Vital Statistics System (NVSS). The majority of nonfatal costs are attributed to hospitalization, while fatal costs are largely attributable to value of lives lost. Previous estimates have not included person-specific measures like lost quality of life and lives lost, which heavily impact the economic burden.

Lead investigator, Gabrielle F. Miller, Health Scientist, National Center for Injury Prevention and Control at CDC, Atlanta, elaborated, “The bulk of the costs associated with firearm injuries across all demographic and geographic categories does not come from the medical costs, but rather from lost quality of life and lives lost.”

Key findings from this analysis include:

  • The total cost of firearm-related injuries and deaths in the United States for 2020 was $493.2 billion, a 16% increase compared with 2019.

  • The cost of fatal firearm injuries vastly outweighs the cost of nonfatal firearm injuries.

    • Nonfatal firearm injuries costs increased from $7.58 billion in 2019 to $9.30 billion in 2020.

    • Fatal firearm injuries costs increased from $418.88 billion in 2019 to $483.90 billion in 2020.

  • There were significant disparities in the cost of firearm related injuries and deaths in 2019−2020 by race/ethnicity, sex, age, and geographic location, including:

    • Non-Hispanic Black people, males, young and middle-aged adults experienced the largest increases in costs related to firearm deaths.

    • Urban areas and the South had higher costs than rural areas and the Northeast, Midwest, and West regions.

    • For firearm homicide, the highest costs were borne by non-Hispanic Black people in 2019−2020, whereas for firearm suicide the highest costs were borne by non-Hispanic White people.

  • Suicide accounted for about half of the total cost of fatal firearm injuries while assaults accounted for close to 1005 of the total cost of nonfatal firearm injuries.

Caption: From 2029 to 2020, the cost of firearm deaths increased 16% with non-Hispanic Black persons, males, young and middle-aged adults experiencing the largest increase (Credit: Centers for Disease Control and Prevention).

James A. Mercy, PhD, Director, Division of Violence Prevention, CDC, Atlanta, added, “The human toll of firearm injuries and deaths in our nation is vast and cannot be fully captured by these economic costs. Nevertheless, these costs are a valuable tool for measuring the economic benefit of the many strategies available that work to prevent firearm deaths and injuries.”

Interventions and preventive measures include reducing access to lethal means among individuals at risk of harming themselves or others, strengthening economic supports and access to health and mental health care, education, and social services, and addressing systemic and structural inequities.

Dr. Miller noted, “Continued prevention efforts can reduce the costs to our society and ease the risks and inequities of the costs associated with firearm injuries and deaths.”

CDC investigates injuries and violence to find the best ways to prevent firearmopens in new tab/window violence and suicideopens in new tab/window, applying science and creating real-world solutions to keep people safe, healthy, and productive. Understanding the economic burden that the immediate and long-term harms of firearm injuries pose on society tells us about the impact of injury prevention.


Notes for editors

The article isCosts of Fatal and Nonfatal Firearm Injuries in the U.S., 2019 and 2020,” by Gabrielle F. Miller, PhD, MPH,Sarah Beth L. Barnett, PhD,Curtis S. Florence, PhD,Kathleen McDavid Harrison, PhD, MPH,Linda L. Dahlberg, PhD, and James A. Mercy, PhD( in new tab/window). It appears online in advance of the American Journal of Preventive Medicine, volume 66, issue 2(February 2024), published by Elsevier.

The article is openly available at in new tab/window.

Full text of this article is also available to credentialed journalists upon request; contact Jillian B. Morgan at +1 734 936 1590 or [email protected]opens in new tab/window. Journalists wishing to interview the authors should contact CDC’s Division of Media Relations at +1 404 639 3286 or [email protected]opens in new tab/window.

The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of CDC.

About the American Journal of Preventive Medicine

The American Journal of Preventive Medicineopens in new tab/window is the official journal of the American College of Preventive Medicineopens in new tab/window and the Association for Prevention Teaching and Researchopens in new tab/window. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials. www.ajpmonline.orgopens in new tab/window

About Elsevier

As a global leader in scientific information and analytics, Elsevier helps researchers and healthcare professionals advance science and improve health outcomes for the benefit of society. We do this by facilitating insights and critical decision-making with innovative solutions based on trusted, evidence-based content and advanced AI-enabled digital technologies.

We have supported the work of our research and healthcare communities for more than 140 years. Our 9,500 employees around the world, including 2,500 technologists, are dedicated to supporting researchers, librarians, academic leaders, funders, governments, R&D-intensive companies, doctors, nurses, future healthcare professionals and educators in their critical work. Our 2,900 scientific journals and iconic reference books include the foremost titles in their fields, including Cell Press, The Lancet and Gray’s Anatomy.

Together with the Elsevier Foundationopens in new tab/window, we work in partnership with the communities we serve to advance inclusion and diversity in science, research and healthcare in developing countries and around the world.

Elsevier is part of RELXopens in new tab/window, a global provider of information-based analytics and decision tools for professional and business customers. For more information on our work, digital solutions and content, visit



Jillian B. Morgan

MPH, Managing Editor AJPM

+1 734 936 1590

E-mail Jillian B. Morgan