Variations in car crash-related hospitalization costs amongst young adults in New South Wales, Australia H.Y. Chen a, *, S. Jan a , S. Boufous a , A.L.C. Martiniuk a , R. Ivers a , T. Senserrick a , R. Norton a , D. Muscatello b a The George Institute for Global Health, The University of Sydney, Australia b Centre for Epidemiology and Research, NSW Department of Health, Australia Introduction The over-representation of young drivers and passengers in severe motor vehicle crashes and the resulting burden to society is of concern worldwide, 1 as well as in Australia. 2 For example, the cost of crashes of drivers aged 15–20 years in the United States (US) was estimated to be US$41 billion in 2002; 3 in Australia, young driver crashes lead to 120 deaths and 2300 severe injuries each year, costing the country more than A$1 billion. 4 Such burden of disease estimates tend to cover all potential social costs related to crash casualties, which provides the macroeconomic context of this health issue. However, the application of such social cost estimates for policy is not always clear. In order to guide investment decisions in the health sector, crash related health care costs and the factors that explain variation in such costs may be of more relevance. A recent study in Australia found that whilst rural young drivers had a lower crash risk than urban young drivers, they were more likely to be involved in single vehicle crashes. 5 However, an analysis quantifying potential regional disparities in crash-related hospital costs amongst young people in Australia has yet to be undertaken. A report from the US in 2008 suggests that the average cost of crashes in rural areas is approximately double that of crashes in urban areas, reflecting the higher proportion of severe Injury, Int. J. Care Injured 43 (2012) 1593–1599 A R T I C L E I N F O Article history: Accepted 6 June 2011 Keywords: Motor vehicle injury Traffic crash Young people Hospitalization cost Rural/urban difference Socio-economic difference A B S T R A C T Background: This study aims to examine factors associated with variation in crash-related hospitaliza- tion costs for young adults in New South Wales (NSW), Australia with a particular focus on types of vehicle occupant, rurality of residence and socioeconomic status (SES). Methods: Data on patients aged 17–25 years, admitted to public hospitals due to a crash during July 2000–June 2007 were extracted from the NSW Health Admission Collection database. The hospitalization cost of each admission was calculated based on published charges for specific Australian Refined-Diagnosis Related Groups (AR-DRG). Multivariable analyses using generalized estimating equations were used to estimate costs by vehicle occupant type (driver, passenger and other occupants), rurality of residence (urban, regional and rural areas) and SES (low, moderate and high SES areas). Results: During 2000–2007, there were 11,892 crash-related hospitalizations involving young adults, aged 17–25 years, in NSW. These cost the health sector about A$87.6 million or on average, A$7363 per hospitalization (mean length of stay (LOS) 5.3 days). Compared to drivers, passengers had significantly longer LOS (<0.01) as well as higher hospitalization costs (p = 0.04). Regional and rural young adults had significantly longer LOS and higher hospitalization costs compared to urban young adults (p < 0.05). Compared with young adults from high SES areas, young adults from moderate SES areas had significantly higher costs (p = 0.02), whilst the higher costs for young adults of low SES areas was borderline significant (p = 0.06), although differences in LOS by SES were not significant. Conclusion: Annually, young adults’ crashes in NSW were estimated to cost the health sector at least A$14.6 million between 2001 and 2007. The higher hospitalization costs and LOS for young adults living in regional and rural vs. urban areas, and those living in moderate and low SES vs. high SES areas partly reflects the severity of these crashes and challenges for treatment. Based on these findings, a strong economic argument can be made for targeting prevention strategies to young people living in rural and low SES areas. The area variations in costs also suggest some scope for policy makers to consider potentially more efficient ways of targeting both treatment and preventative programmes. ß 2011 Elsevier Ltd. All rights reserved. * Corresponding author at: C-MARC, School of Public Health, Curtin University of Technology, GPO Box U1987, Perth, WA 6845, Australia. Tel.: +61 8 9266 9590; fax: +61 8 9266 2958. E-mail address: huei-yang.chen@curtin.edu.au (H.Y. Chen). Contents lists available at ScienceDirect Injury jo ur n al ho m epag e: ww w.els evier .c om /lo cat e/inju r y 0020–1383/$ – see front matter ß 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2011.06.016