Guns can be useful for hunting excursions, sport shooting and self-defence. Canadians living in wilderness regions rely on guns for securing food and protecting themselves against animal attacks. 1 However, a large downside of guns is the risk of injury. In Canada, mortality from gun injuries amounts to 800 total deaths annually, equivalent to a rate of 23 deaths per million per year. 2 An estimated 700 fewer Canadians would die from gun injury each year if per capita mortality rates in Canada matched those in the United Kingdom. 3,4 Some countries have a higher mortality from gun injuries, including the United States with a rate of about 200 deaths per million population per year. 5 Many people survive gun injury, which means mortality rates may underestimate the total health losses. 6 For example, some patients with through-and-through brain injuries (i.e., from a bullet that has passed through leaving entry and exit wounds) stay alive but reside in long-term care institutions. 7 The intensity of pain or neurologic deficits associated with gun injury can be severe and lasting. 8 Up to half of those with gun injury show anxiety, depression or other signs of stress while in hospital. 9,10 Disfigurement can lead to further complications. 11 Conversely, some patients view survivorship as a source of personal pride, community prestige or divine intervention. 12,13 However, aside from reports after military combat, rigorous studies are near-silent about long-term prognosis and instead focus on acute care survival. [14][15][16] The aim of this study was to examine whether the risks of death and long-term disability are substantial after gun injury, contrary to the rapid recoveries depicted in some action movies. Moreover, we hypothesized that intentional gun injury, relative to unintentional gun injury, would lead to a greater burden of long-term disability because of the differences in wound anatomy, patient characteristics, injury circumstances, trauma severity, counterfactual reasoning, psychological outrage and community supports. [17][18][19] Herein we explore this distinction and apply population-wide health care databases to examine long-term outcomes for patients who survive gun injury.
