Bruce A Lawrence

• Ph.D.
• Researcher at Pacific Institute for Research and Evaluation

Objective: The objective of this study was to compare drink driving and related road safety issues in 2 urban areas of 6 countries and develop an equation for estimating the rate of crash underreporting to the police in urban areas of countries that lack this information. Methods: This study is a secondary analysis of 1 to 2 waves of surveys in...

In 2019 there were 36,500 people killed, 4.5 million people injured, and 23 million vehicles damaged in motor vehicle crashes in the United States. The economic costs of these crashes totaled $340 billion, including lost productivity, medical, legal and court costs, emergency service, insurance administration, congestion, property damage, and workp...

Background Quality-adjusted life years (QALYs) provide a means to compare injuries using a common measurement which allows quality of life and duration of life from an injury to be considered. A more comprehensive picture of the economic losses associated with injuries can be found when QALY estimates are combined with medical and work loss costs....

Statement of Purpose We identify fatal, and hospital treated injuries to motorcyclists, pedalcyclists, and pedestrians in motor vehicle crashes (MVCs) and estimate the financial impact of these injuries. Methods/Approach We computed costs of crash injuries to these vulnerable road users by multiplying 2018 incidence by age group, sex, travel mode,...

Statement of Purpose This study updates costs for fatal and hospital-treated injuries to vehicle occupants in motor vehicle crashes (MVCs), which last were published in 2005. Methods/Approach We computed costs of crash injuries to motor vehicle occupants by multiplying 2018 incidence by age group, sex, and injury severity times corresponding unit...

Introduction: In addition to the nearly 40,000 firearm deaths each year, nonfatal firearm injuries represent a significant public health burden to communities in the United States. We aimed to describe the incidence and rates of nonfatal firearm injuries. Methods: We calculated nonfatal firearm injury estimates using the Healthcare Cost and Util...

Importance Prior lethality analyses of suicide means have historically treated drug poisoning other than alcohol poisoning as a lumped category. Assessing risk by drug class permits better assessment of prevention opportunities. Objective To investigate the epidemiology of drug poisoning suicides. Design, Setting, and Participants This cross-sect...

Background: Traumatic brain injury (TBI) is prevalent in children and adolescents ages <1–19 years, yet we have limited understanding of consumer products that are associated with TBIs in children and adolescents of varying ages. To address this gap, we combined two data sources to investigate leading products and activities associated with TBIs in...

Objective: Despite the rising toll of drug poisoning deaths in the United States, the extent of the problem among adolescents and young adults ages 15-24 years has received relatively little attention. We examined sociodemographic characteristics and state trends in drug poisoning deaths among adolescents and young adults from 2006 to 2015 and est...

Consumer products are often associated with fall injuries, but there is limited research on nonfatal unintentional falls in children that examines both the child’s age group and the involvement of consumer products and activities. We combined 2 data sources to investigate products and activities that contribute to fall injuries in children at diffe...

SupplementMaterial_CL – Supplemental material for Consumer Products Contributing to Fall Injuries in Children Aged <1 to 19 Years Treated in US Emergency Departments, 2010 to 2013: An Observational Study

Background: Injuries are a leading cause of death and acquired disability, and result in significant medical spending. Prior estimates of injury-related cost have been limited by older data, for certain population, or specific mechanisms. Findings: This study estimated the incidence of hospital-treated nonfatal injuries in the United States (US) i...

This paper aims to estimate lifetime costs resulting from abusive head trauma (AHT) in the USA and the break-even effectiveness for prevention. A mathematical model incorporated data from Vital Statistics, the Healthcare Cost and Utilization Project Kids’ Inpatient Database, and previous studies. Unit costs were derived from published sources. From...

Introduction Emergency department visits and hospital admissions resulting from adult bicycle trauma have increased dramatically. Annual medical costs and work losses of these incidents last were estimated for 2005 and quality-of-life losses for 2000. Methods We estimated costs associated with adult bicycle injuries in the USA using 1997–2013 non-...

Background: Estimates of economic and social costs related to alcohol and other drug (AOD) use and abuse are usually made at state and national levels. Ecological analyses demonstrate, however, that substantial variations exist in the incidence and prevalence of AOD use and problems including impaired driving, violence, and chronic disease between...

Objective: To count and characterise injuries resulting from legal intervention by US law enforcement personnel and injury ratios per 10 000 arrests or police stops, thus expanding discussion of excessive force by police beyond fatalities. Design: Ecological. Population: Those injured during US legal police intervention as recorded in 2012 Vit...

Background Governments wish to compare their performance in preventing serious injury. International comparisons based on hospital inpatient records are typically contaminated by variations in health services utilisation. To reduce these effects, a serious injury case definition has been proposed based on diagnoses with a high probability of inpati...

Background In 2012 in the United States, 13,454 children and adolescents died due to injury and another 9 million visited the emergency department or were hospitalised. However, incidence tells only part of the story. Costs are a better measure of burden by accounting for multiple injury consequences – death, severity, disability – in a single unit...

Background Both the US Centres for Disease Control and Prevention’s WISQARS system and the Healthcare Cost and Utilisation Program (HCUP) provide sample-based national estimates of injury survivors treated in hospital emergency departments and released (ED cases) or admitted. The WISQARS sample is much smaller but also more quickly available and mo...

BACKGROUND: Preventing traffic crashes reduces crash costs paid by employers and employees. The related savings filter through the economy, impacting its performance. This study is the first to measure the impact of traffic crash reduction on a national economy. It focuses on impaired driving crashes. METHODS: We analysed the impact of the almost...

Background: Products under the purview of the Consumer Product Safety Commission are involved in a large share of injuries and injury costs in the USA. Methods: This study analyses incidence data from the National Electronic Injury Surveillance System (NEISS) and cost data based on the Injury Cost Model, integrated with the NEISS. We examined the...

OBJECTIVE: We estimated the disability-adjusted life-year (DALY) burden of abusive head trauma (AHT) at ages 0 to 4 years in the United States. METHODS: DALYs are computed by summing years of productive life that survivors lost to disability plus life-years lost to premature death. Surveying a convenience sample of 170 caregivers and pediatricians...

This document describes the methods used to estimate costs of injury in the Web-based Injury Statistics Query and Reporting System (WISQARS) of the Centers for Disease Control and Prevention (CDC). The WISQARS database is an interactive query system that provides customized reports of injury-related data. It provides national and state statistics o...

In 2010, there were 32,999 people killed, 3.9 million were injured, and 24 million vehicles were damaged in motor vehicle crashes in the United States. The economic costs of these crashes totaled $277 billion. Included in these losses are lost productivity, medical costs, legal and court costs, emergency service costs (EMS), insurance administratio...

Background: No one knows whether the temporality of nonfatal deliberate self-harm in the United States mirrors the temporality of suicide deaths. Aims: To analyze day- and month-specific variation in population rates for suicide fatalities and, separately, for hospital admissions for nonfatal deliberate self-harm. Methods: For 12 states, we extract...

Estimate the annual US incidence and cost of fatal and nonfatal youth injury in agricultural settings. We used 2001-2006 Childhood Agricultural Injury Survey data to estimate the incidence of nonfatal injury and 2001-2006 Multiple Cause of Death data to estimate the incidence of fatal injury. To estimate the costs for injuries suffered by youth wor...

We analyzed alcohol involvement in 84,005 medically identified live discharges for self-inflicted intentional injuries (typically suicide acts) from hospitals in 20 U.S. states in 1997. Alcohol was involved in 27% of the discharges. Evidence of alcohol was significantly more prevalent in men than women, but generally men drink more than women. Blac...

Background. Each year, more than a million people are killed in motor vehicle crashes worldwide. Crashes place a tremendous burden on societies not only in terms of lives lost but also in terms of cost. While there are many evidence-based road safety interventions that exist, many of these interventions are underutilised. Economic studies are a use...

To estimate the costs of motor vehicle-related fatal and nonfatal injuries in the United States in terms of medical care and lost productivity by road user type. Incidence and cost data for 2005 were derived from several data sources. Unit costs were calculated for medical spending and productivity losses for fatal and nonfatal injuries, and unit c...

Durkheim's nineteenth-century analysis of national suicide rates dismissed prior concerns about mortality data fidelity. Over the intervening century, however, evidence documenting various types of error in suicide data has only mounted, and surprising levels of such error continue to be routinely uncovered. Yet the annual suicide rate remains the...

The Consumer Product Safety Commission (CPSC) contracted with the Pacific Institute for Research and Evaluation (PIRE) to undertake new estimates of the incidence and costs of medically treated injuries resulting from residential fires. Using various national data sets, PIRE produced estimates of incidence at five levels: fatal, admitted to a burn...

Objective: We determined the rate and costs of recent U.S. all-terrain vehicle (ATV) and bicycle deaths. Methods: Fatalities were identified from the National Center for Health Statistics Multiple Cause-of-Death public-access file. ATV and bicycle deaths were defined by International Classification of Diseases, 10th Revision codes V86.0-V86.9 and...

Purpose. To estimate the costs of recreational boating injuries in the United States. Data and Methods. We applied previously developed cost-estimating methods, similar to those used by the Department of Transportation, to boating-related injury cases in national and state mortality and medical discharge data sets. We grouped the costed cases by...

This study evaluates the quality of injury-related coding in state hospital data and their usefulness to injury researchers. Using 1997 hospital discharge records from 19 states, hospitalized non-fatal injury-related cases were identified by first selecting all cases that met broad criteria for injury, and then dropping cases that appeared incorrec...

The study team investigated the extent of under-reporting of recreational boating accidents by comparing fatal and non-fatal injury data captured by the BARD System in calendar year 2002 with data for the same period from other government sources widely used in the analysis of injuries.

Injuries are one of the most serious public health problems facing the United States today. Through premature death, disability, medical cost and lost productivity, injuries impact the health and welfare of all Americans. Deaths only begin to tell the story. Although many injuries are minor, a large proportion result in fractures, amputations, burn...

Historically, fatal injury monitoring and surveillance have relied on mortality data derived from death certificates (DC). However, problems associated with utilizing DC have been well documented. Recently, access to and utilization of hospital discharge data (HDD) have offered a new and important secondary source of data regarding in-hospital deat...

Trauma has been suggested, in case series, as one of the nonatherosclerotic mechanisms leading to acute myocardial infarction (AMI), the leading cause of death in the US. AMI following non-penetrating injury has been shown to carry significant morbidity and mortality. To determine whether hospitalized injuries in a large multi state population are...

Cardiac injury has been well recognised as a complication of blunt chest trauma. Its clinical spectrum ranges from blunt cardiac injury (BCI) to complete rupture of cardiac tissues, with cardiac valvular injury often being overlooked. To determine whether hospitalised BCI is associated with increased risk of cardiac valve insufficiency in a large m...

Unintentional home injuries impose significant, but little reported, costs to society. The most tangible are medical and indirect costs. A less-tangible cost is the value of lost quality of life due to impairment or death. A societal perspective was adopted in estimating unintentional home injury costs. All costs associated with the injuries are in...

Since 1997, hospital discharge data have included external cause of injury (E codes) for designating perpetrator relationship in assaults. For intentional injuries, guidelines require using two E codes; one for the injury mechanism and another (E967.n) identifying perpetrator relationship. Completeness and characteristics of the use of these codes...

This paper estimates the incidence, unit costs, and annual costs of pedestrian and pedalcycle crash injuries in the United States. It includes medical care costs, household and wage work losses, and the value of pain, suffering, and lost quality of life. The estimates are broken down by body region and severity. They rely heavily on data from the h...

Background. In 10% of poisoning cases in state hospital discharge data, the intent could not be determined from the hospital record. Suicide attempts account for a majority of nonfatal hospital-admitted poisonings. Conversely, a majority of nonfatal suicide attempts (ca. 70%) involve poisoning. Therefore, the inability to determine the intent of so...

This paper presents cost-outcome analyses of five injury prevention efforts in Native American jurisdictions: a safety-belt program, a streetlight project, a livestock control project, a drowning prevention program, and a suicide prevention and intervention program. Pre- and post-intervention data were analyzed to estimate projects' impact on injur...

Motor vehicle insurance information is critical to understanding highway crash costs and who pays them. To address this need, PIRE obtained unpublished data from six insurers that specialize in motorcycle insurance, along with parallel data from the nation’s five largest motor vehicle insurers. Both insured motorcycles and other private passenger...

Determining the magnitude of the burden of diseases and health disorders on the U.S. population is a high priority for health policy makers. Conditions such as malignant neoplasms and injuries from craniofacial trauma contribute to adverse oral health. This study estimates the number of cases of diseases and disorders relevant to oral health that a...

PIRE analysts reviewed 25 motorcycle safety studies, mostly from the 1990s, on the costs of injuries resulting from motorcycle crashes. Most of the studies employed data from a state, locality, or medical institution, and seven linked data from multiple sources - e.g., police crash reports and hospital records - with varying degrees of success. Oth...

OBJECTIVE: To determine the rate of pregnancy-associated hospitalized assaults in a multistate population and whether they have any increased assault risk versus nonpregnant counterparts. METHODS: An International Classification of Diseases, 9th Revision (ICD-9-CM) pregnancy and injury criterion was applied to 1997 statewide hospital discharge data...

The US Consumer Product Safety Commission is considering handlebar regulation regarding impact performance to address the risk of abdominal and pelvic organ injuries in bicyclists. To provide national estimates of incidence and costs of handlebar-related abdominal and pelvic organ injuries. Censuses of hospital discharge data from 19 states were ex...

This project aims to provide defensible costs per case and total costs for occupational injuries and illnesses. We proposed to provide these costs by diagnosis, age, gender, occupation, industry and state wherever possible. In order to analyze the cost effectiveness of safety interventions, we aimed to include estimates of the effect of ill health...

Hospitalized maternal injuries pose a serious threat to the fetus, therefore understanding their burden is important. In addition, this study examined whether the risk of serious injury from crashes changes during pregnancy. Using 1997 hospital discharge data from 19 states, injuries to younger women were classified as motor-vehicle related with an...

This paper describes a data-driven injury cost model (ICM) developed to estimate the costs associated with non-fatal consumer product injuries. The modeling effort combines information by diagnosis from the US Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS) and 17 other large data sets. The ICM contains f...

This paper presents cost-outcome analyses of four transportation injury prevention efforts in Native American jurisdictions. Pre- and post-intervention data were analyzed to estimate projects' impact on injury reduction. Projects' costs were amortized over the time period covered by the evaluation or over the useful life of physical capital investe...

The cost of treating gunshot injuries imposes a financial burden on society. Estimates of such costs are relevant to evaluation of gun violence reduction programs and may help guide reimbursement policies. To develop reliable US estimates of the medical costs of treating gunshot injuries and to present national estimates for the sources of payment...

Alcohol-involved crashes cost society more than $100 billion a year. Sobriety checkpoints are effective in apprehending drunk drivers. This article compares the costs and the estimated monetary benefits from a hypothetical community sobriety checkpoint program. The analysis is constructed around a hypothetical community with 100,000 licensed driver...

Beginning with William Niskanen's hypothesis that a bureau is a budget maximizer, this dissertation explores various possibilities for the bureau's sponsor to extract an outcome from the bureau more favorable to itself through a series of game-theoretic economic models. An important finding is that if the sponsor (e.g., Congress) politically binds...