Last year, as survivors of the school shooting in Uvalde, Texas, struggled to manage both their grief and newfound financial strain, their stories echoed those of other shooting survivors, for whom the combined burden of grief, trauma, and medical bills can be overwhelming. 

Following a shooting, mounting medical debt, loss of employment, and mental health treatment can all take a significant toll on people who have been shot. While simultaneously trying to manage a return to some version of normalcy, many of these victims often have to navigate crippling expenses. Survivors may receive support and services from local and regional providers if it is available, but on a national level, the financial strain of firearm violence is not easily quantified.

In response to readers’ questions, we explore what researchers have been able to discover about the financial costs of gun violence — and what is left out.

What does gun violence cost, broadly?

Gun violence costs significantly more in America than in any other developed nation. According to the latest available data from the Centers for Disease Control and Prevention, in 2020, medical expenses for firearm injuries totaled $289.5 million. 

But an exact figure does not exist. Research indicates that differences in initial medical care, insurance, follow-up care, and changes in lifestyle all contribute to a wide estimated range of the cost of gun violence. Evaluations that look at additional measurements outside of primary medical care, like prescription medication and follow-up treatment, will yield significantly higher estimates. 

In an attempt to break down these estimates — and pinpoint differences — various studies published in recent years have analyzed several factors, including initial hospitalizations, type of injuries, medication, and additional surgeries. Researchers across the country have therefore estimated that gun violence in the U.S. annually costs roughly between $229 million and $557 billion. 

“This is an issue that has long-term effects and costs everyone,” said Evan Gumas, a research associate at the Commonwealth Fund, in an email to The Trace. Gumas was part of the research group that statistically visualized the price of American gun violence, part of the Fund’s private efforts to support healthcare research and improve policy.

The CDC’s 2020 data also highlighted differences in expenses depending on the type of firearm injury. Homicidal injuries were the most expensive, averaging $9,030 per event. Suicidal injuries cost less than half of that, averaging $4,069.

How do these studies define cost, and what’s left out?

Cost is often associated with medical expenses, as this is typically the most accessible data for researchers. Initial hospitalizations are expensive, a study conducted by the University of Chicago found. It analyzed primary treatment charges for firearm-related injuries between 2006 and 2014, an estimated $734.6 million annually. 

Another study published in 2022 found that personal medical costs increased an average of $2,495 per month in the first year following a shooting. This study also found that survivors had a 40 percent increase in pain diagnoses, which often resulted in the need for additional medical treatment. For people who survive shootings, in the first year alone, medical care can total up to around $30,000.

However, medical costs account for only a fraction of the expenses. There is limited research on longer-term or lifetime care following a patient’s recovery process. Depending on the gravity and location of the wound, patients may need medical attention and support for the duration of their lives. Though research is similarly limited regarding friends and families caring for victims of gun violence, they are often the only resort a survivor has, taking significant time away from work and joining the ranks of 53 million Americans providing unpaid caregiving for a person with a serious medical condition. 

Why are mental health costs so difficult to measure?

Following a shooting, there is not only the need to address the physical wounds but also the survivors’ emotional distress — short and long-term. A recent study by Harvard Medical School, found that psychiatric diagnoses increased by 52 percent following a shooting, and others have similarly indicated that gun violence exposure is closely enmeshed with mental health. But academic studies that weigh the financial expenses attributed to mental health and gun violence are rare. 

The Harvard Medical School cohort study mentioned above found that there is not only an increase in psychiatric diagnoses for people who were shot, but the overall mental health of the victim’s family members also worsened. Family member psychiatric diagnoses increased by 12 percent following a shooting. The same study found that substance abuse among victims increased by 85 percent following a shooting.

It is difficult to calculate the mental costs of gun violence for multiple reasons, partly because for more than two decades the CDC couldn’t study gun violence by law. And patients who need mental health resources following a shooting often struggle to access them or pay for them, a gap that limits research on such care.

Are gun violence costs directly connected to tax dollars?

Short answer: yes. Research estimates that from 2003 to 2013, nearly two-thirds of all firearm injury patients admitted to hospitals in the U.S. were uninsured or were insured by Medicaid, which jointly insures around 90 million low-income Americans with federal and state resources, accounting for nearly $400 million in average costs per year.

A separate analysis showed that Medicaid patients were more likely to be readmitted to the hospital for follow-up care following a shooting, compared to those who are privately insured. There is limited information on why this is the case, but researchers have explained that unequal access to adequate healthcare exacerbates the cost of firearm injuries, and there needs to be better healthcare options and insurance for survivors.

“There are some elements of gun violence that directly cost taxpayers, such as medical care and supporting people who are permanently injured, but that is a tiny fraction of the total cost,” said Philip J. Cook, an economist and researcher in the field of gun violence. “The much larger cost is the value of quality of life, and it does not show up in our taxes.” 

How does it break down by region?

A 2022 study found that gun injuries in the South cost significantly more than in other regions of the United States; over a 10-year period, on average, firearm injuries in the region accounted for 41 percent of the total costs of firearm-related hospital admissions. Costs in the Northeast were the lowest of any of the four regions, accounting for nearly 14 percent of the total. 

The same study also found that although the South had the largest financial burden over a 10-year period, government spending was lowest there, at 34.3 percent. By contrast, coverage was highest in the Northeast, with 56 percent of total costs covered by government payments. This is because, although programs like Medicare are handled by both the federal and state governments, states often determine the stipulations around expansion and policies.

Analyses show that there are regional differences in government medical spending, but political affiliation is the biggest identifier of how governments choose to handle healthcare; Republican-controlled states have continually blocked initiatives around Medicaid expansion. Given that a large percentage of gun violence victims are insured by public programs like Medicaid, efforts to limit the program’s access consequently impact survivors

A report conducted by the Government Accountability Office, an independent organization that gathers information to provide to Congress, had similar findings in 2021: Southern states had half of all initial hospital stays, although the South made up only 38 percent of the U.S. population at that time.

How do gun violence costs intersect with other parts of the economy?

Gun violence not only accrues medical costs but contributes to the loss of employment, educational attainment, and housing for those directly and indirectly impacted by it. A 2017 study led by Yasemin Irvin-Erickson, assistant professor of criminology, law, and society at George Mason University and the Urban Institute, evaluated data from 2009 to 2015 on the financial impact of gun violence in urban communities. The results showed that in cities like Minneapolis, gun homicide in a census tract led to 80 fewer available jobs the following year. In Washington, D.C., each gun homicide was related to two fewer retail or service establishments in that census tract the following year. The findings also showed that gun homicide led to a $22,000 decrease in average home values in Minneapolis and a $24,621 decrease in Oakland, California.

Research from the city of Philadelphia found that in 80 percent of ZIP codes citywide, there was a correlation between unemployment and rates of gun violence; the ZIP codes with the highest rates of chronic unemployment had more shooting victims.

Exposure to gun violence also impacts educational attainment. Research shows that students who survive shootings are 10 percent less likely to attend college and 15 percent less likely to graduate college. An analysis of Texas school shootings found that exposure to a school shooting increased absenteeism and grade repetition. 

“Compared to almost any other health outcome that has the cost burden of firearm injuries, we are woefully behind,” said Corinne Peek-Asa, the vice chancellor of research at UC San Diego, who analyzed the costs of hospitalization of firearm injuries. “Research is needed in particular because firearm injury is a polarized issue, and only good evidence will help us follow the most successful path in reducing the burden that firearm injuries pose to us.”