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On one level, it's almost impossible to put a dollar figure on lives shattered by gun violence or to try to measure the pain of having a loved one killed or seriously injured.   

But researchers of two new studies using federal health care and hospital data underscore that the repercussions from firearm deaths and injuries are deeper, wider and far costlier than previously known.  

 in the Annals of Internal Medicine, Dr. Zirui Song and colleagues found a four-fold increase in health care spending as a direct result of a non-fatal firearm injury. 

Dr. Song, an Associate Professor of Health Care Policy and Medicine at Harvard Medical School, also charts a substantial increase in other health disorders that undermine a person's health and well-being. 

 "In the first year after a non-fatal firearm injury, survivors experienced a 40 percent increase in physical pain or other forms of pain syndromes; a 50 percent increase in psychiatric disorders; and an 85 percent increase in substance use disorders," Dr. Song says, while on break from his rounds at Massachusetts General Hospital, where he practices internal medicine. He adds more research is needed as to exactly why those addiction numbers and other disorders go up so dramatically.

"These results are disturbing and we, as a research team, found them quite striking, as well," he says. "The ripple effects are quite profound and meaningful for both survivors and family members and, I would argue, clinically and economically substantial."

And those effects aren't just on those injured by bullets. The study shows family members of survivors, too, can carry massive physical and mental burdens. 

"Family members on average, including parents, siblings and children, experienced a 12 percent increase in psychiatric disorders," he says.

The study is based largely on healthcare claims data, not hospital survey or discharge data. Dr. Song says that allows for a more detailed look at spending than previous studies based on other types of data.  

"There is really an undercurrent of forgotten survivors whose own health and economic conditions are affected quite profoundly, even though they were lucky enough to survive," he tells NPR. 

And the financial burden for this fallout is mostly landing on the shoulders of taxpayers and employees: Dr. Song's study shows 96 percent of the increase in health care spending on firearm injuries is shouldered by Medicare and U.S. employers.  

"In direct costs alone, it's $2.5 billion in healthcare spending in the first year after non-fatal firearm injuries," he says. "This number is much larger if you include indirect costs of lost wages or productivity." 

out this week by Everytown for Gun Safety

 delves into that larger picture and looks at a wide range of direct and indirect costs from all gun violence in America, fatal as well as gun injuries. 

"This epidemic is costing our nation $557 billion annually," says Sarah Burd-Sharps, research director at the gun control advocacy group.  "Looking at the economic consequence offers a wider lens for understanding just how extensive — and expensive — this crisis is." 

The $557 billion figure seems astonishing. But the group says it looks at myriad direct costs associated with gun violence. Researcher Burd-Sharps notes the figures include immediate costs of a shooting, such as the police response, investigations and ambulance services all the way to the long-term health care costs. The analysis also includes estimates for a victims' lost earnings, costs incurred by the criminal justice system, the price of mental health care and more.

"Whenever you're costing these kind of injuries, you have to take into consideration that quality of life amount, which is admittedly quite large," she says. 

In fact, Burd-Sharps believes the true annual figure is even higher than the estimate in the report that society loses some $1.34 billion every day for pain and suffering related to all victims of gun violence.

"This is honestly a very conservative estimate," she says. "It covers directly measurable costs. It doesn't cover things like the trauma of children who don't want to return their school. The impact on businesses or on property, you know, values and taxes. It doesn't cover any of those wider reverberations."

 before two Congressional committees this week on the economic impact of gun violence. 

She says she'll tell lawmakers the group is grateful for their recent federal actions on guns, which included incentives for states to pass "red flag'' laws, which temporarily remove a weapon from a person deemed dangerous, and expanded background checks for those between of the ages of 18 and 21 who wish to buy a gun.

But Burd-Sharps says she'll also tell the Congress members that "much more is needed to fight this epidemic." 

Crime, Law and Justice

Eric Westervelt

Author

Two new studies outline the massive financial, social and healthcare costs of America's gun violence epidemic on victims and the large pool of often forgotten survivors. 

American gun violence has immense costs beyond the death toll, new studies find

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