Firearm injury epidemiology in children and youth in Ontario, Canada: a population-based study

Abstract

Background and objectiveDespite firearms contributing to significant morbidity and mortality globally, firearm injury epidemiology is seldom described outside of the USA. We examined firearm injuries among youth in Canada, including weapon type, and intent.DesignPopulation-based, pooled cross-sectional study using linked health administrative and demographic databases.SettingOntario, Canada.ParticipantsAll children and youth from birth to 24 years, residing in Ontario from 1 April 2003 to 31 March 2018.ExposureFirearm injury intent and weapon type using the International Classification of Disease-10 CM codes with Canadian enhancements. Secondary exposures were sociodemographics including age, sex, rurality and income.Main outcomesAny hospital or death record of a firearm injury with counts and rates of firearm injuries described overall and stratified by weapon type and injury intent. Multivariable Poisson regression stratified by injury intent was used to calculate rate ratios of firearm injuries by weapon type.ResultsOf 5486 children and youth with a firearm injury (annual rate: 8.8/100 000 population), 90.7% survived. Most injuries occurred in males (90.1%, 15.5/100 000 population). 62.3% (3416) of injuries were unintentional (5.5/100 000 population) of which 1.9% were deaths, whereas 26.5% (1452) were assault related (2.3/100 00 population) of which 18.7% were deaths. Self-injury accounted for 3.7% (204) of cases of which 72.0% were deaths. Across all intents, adjusted regression models showed males were at an increased risk of injury. Non-powdered firearms accounted for half (48.6%, 3.9/100 000 population) of all injuries. Compared with handguns, non-powdered firearms had a higher risk of causing unintentional injuries (adjusted rate ratio (aRR) 14.75, 95% CI 12.01 to 18.12) but not assault (aRR 0.84, 95% CI 0.70 to 1.00).ConclusionsFirearm injuries are a preventable public health problem among youth in Ontario, Canada. Unintentional injuries and those caused by non-powdered firearms were most common and assault and self-injury contributed to substantial firearm-related deaths and should be a focus of prevention efforts.

Fatal and non-fatal firearm-related injuries in Canada, 2016–2020: a population-based study using three administrative databases

“…Our study adds Canadian data to the existing evidence demonstrating that males have significantly higher rates of firearm-related injuries compared with females (Saunders et al 2021 ; Kaufman et al 2021 ; Johns Hopkins-Center for Gun Violence Solutions 2020 ). Firearm homicide rates peaked in the 20- to 34-year-old age group, whereas firearm suicide rates were highest at age 65 or older (Kaufman et al 2021 ; Allareddy et al 2012 ).…”

“…Surveillance data showed that firearm injuries and deaths among youth declined from 1979 to 2003 (Pan et al 2007 ). More recent studies have shown few firearm injuries among younger children, but a rising incidence among youth (Saunders et al 2021 ; Cox et al 2019 ). However, the majority of those injuries involved non-powder firearms such as BB guns and airguns (Saunders et al 2021 ; Cox et al 2019 ).…”

“…Hospitalizations and ED visits involving injuries from BB guns, air guns or flare guns were excluded; however, they were not excluded from death data as ICD codes were not detailed enough to specify these non-powdered firearms. Previous research suggests that the majority of firearm injuries from non-powdered firearms occur in youth and young adults under the age of 25 and that the fatality rate from these injuries is very low (Freeman et al 2017 ; Saunders et al 2021 ; Cox et al 2019 ).…”

Clinical characteristics of firearm-related injuries in children in Turkey

“…19 In the present study, the mortality rate was highest among those with self-directed firearm injuries than in the other groups, which is similar to the findings of earlier studies. [20][21][22] A continuous rise can be seen in cases of self-harm by firearms among children 20 , and previous studies have reported that firearm-related injuries contribute to the rate of disabilities among children, making gun violence an important public health issue. 7 Around half of all children hospitalized with firearm injuries are discharged with disabilities.…”

Dangerous “Toys”: The Burden of Non-Powdered Firearm Injuries in Canadian Children and Youth

“…Most injuries were unintentional, but a significant number were related to assault or were self-inflicted (Figure 1). Young people living in low-income neighbourhoods were at the highest risk of experiencing firearm injuries across all weapon types and intents (Saunders et al 2021). One in every six non-powdered firearm injuries occurred in children 12 years of age and younger.…”