New study on Correlation Between Firearm-Related Hospitalizations and U.S. Stock Market Performance

Economic climate may impact incidence of firearm-related injuries and fatalities, which pose a burden on U.S. healthcare resources, reports The American Journal of Medicine

Philadelphia, PA, April 15, 2015

Over 2001-2011, the national incidence of firearm-related hospitalizations has closely tracked the national stock market performance, suggesting that economic perturbations and resultant insecurities might underlie the perpetuation of firearm-related injuries, according to a new study published in The American Journal of Medicine. Although the fatality rates have remained stable over the last two decades, the average length of stay and hospitalization costs have increased, imposing additional burden on existing healthcare resources.

Firearms are the second leading cause of injury-related deaths after motor vehicle accidents in the U.S. with approximately 88 people dying every day, including suicides, homicides, unintentional injuries, or accidents. “Although there is a large amount of literature detailing the vital statistics relating to firearm-injuries, there is a conspicuous paucity of literature exploring burden on healthcare resources imposed by firearm injuries,” explained author Shikhar Agarwal, MD, MPH, Department of Cardiovascular Medicine, Cleveland Clinic. “One could surmise that there would be a relationship between the national economic situation and national firearm-related hospitalization rates.”

Dr. Agarwal analyzed data from the Nationwide Inpatient Sample (NIS) database from 2001-2011, which indicated that 70,974 hospitalizations were the result of firearm-related injuries. The number of hospitalizations fluctuated during this timeframe with a modest increase during 2002 and 2004, a slow decline until 2008, a sharp increase in 2009 and 2010, followed by a sharp decline in 2011.

The overall fatality rate for hospitalization following firearm-related injury has been stable at about 8%, with suicide responsible for more than 30% of those deaths. Analysis of the data also showed that there has been an increase in the prevalence of mental-health disorders among people admitted with firearm-related injuries.

Using the Dow Jones Industrial Average as an indicator of the overall economic health of the country, Dr. Agarwal determined that “the national incidence of firearm-related hospitalizations in the US has closely tracked the national stock market performance, suggesting that economic perturbations may be a ‘root cause’ or at least an important predictor of firearm injuries.”

Chart PR
Caption: This figure demonstrates the correlation between the trend of firearm-related hospitalizations and the U.S. stock market performance as measured by Dow Jones Industrial Average values. Panel A demonstrates the trend of annual national incidence of firearm-related hospitalizations during 2001-2011. Panel B represents the trend of the Dow Jones Industrial Average during 2001-2011.

Separating the data into two time intervals, 2001-2006 and 2007-2011, Dr. Agarwal found that there was a small but significant drop in the number of patients discharged to home during the later time interval. In addition, the average length of stay following firearm-related injury increased from 6.6 days in 2001-2006 to 7.4 days in 2007-2011, including a significant increase in the proportion of patients who were in hospital for more than 10 days (18.1% in 2001-2006 to 20.8% in 2007-2011.) This was also associated with an average hospitalization cost of $25,155 in 2007-2011 vs. $20,686 in 2001-2006.


Notes for Editors
“Trends and Burden of Firearm-Related Hospitalizations in the United States Across 2001-2011,” by Shikhar Agarwal, MD, MPH (DOI: It appears in The American Journal of Medicine, Volume 128, Issue 5 (May 2015) published by Elsevier.

Full text of this article is available to credentialed journalists upon request. Contact Jane Grochowski at +1 215-239-3712 or to obtain copies. Journalists wishing to interview the author should contact Tora Vinci, Public & Media Relations Manager, Cleveland Clinic, at +1 216-444-2412 or

About The American Journal Of Medicine
The American Journal of Medicine
(, known as the “Green Journal,” is one of the oldest and most prestigious general internal medicine journals published in the United States. It has an Impact Factor of 5.302, which ranks it 14 out of 150 General and Internal Medicine titles according to the 2013 Journal Citation Reports® published by Thomson Reuters.

AJM, the official journal of The Association of Professors of Medicine, a group comprised of chairs of departments of internal medicine at 125-plus US medical schools, publishes peer-reviewed, original scientific studies that have direct clinical significance. The information contained in this article in The American Journal of Medicine is not a substitute for medical advice or treatment, and the Journal recommends consultation with your physician or healthcare professional. AJM is published by Elsevier.

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