Sociodemographic Factors and Outcomes by Intent of Firearm Injury

Abstract

BACKGROUND AND OBJECTIVES: Firearm injuries are a leading and preventable cause of morbidity and mortality among youth. We sought to explore differences in sociodemographic factors and youth firearm injury outcomes by injury intent (unintentional, assault, and self-harm). METHODS:We conducted a repeated cross-sectional analysis of emergency department (ED) visits among youth aged 21 and younger presenting to an ED with a firearm injury between 2009 and 2016 using the Nationwide Emergency Department Sample. We performed multivariable logistic regression to measure the strength of association between (1) patientlevel factors, (2) visit-level characteristics, and (3) clinical outcomes and intent of firearm injury. RESULTS:We identified 178 299 weighted visits for firearm injuries. The mean age was 17.9 (95% confidence interval 17.8-18.0) years; 89.0% of patients were male, 43.0% were publicly insured, 28.8% were admitted, and 6.0% died. Approximately one-third of the injuries were categorized as unintentional (39.4%), another third as assault (37.7%), and a small proportion as self-harm (1.7%). Unintentional firearm injuries were associated with younger age, rural hospital location, Southern region, ED discharge, and extremity injury. Self-harm firearm injuries were associated with older age, higher socioeconomic status, rural hospital location, transfer or death, and brain, back, or spinal cord injury. Firearm injuries by assault were associated with lower socioeconomic status, urban hospital location, and requiring admission. CONCLUSIONS:We identified distinct risk profiles for youth with unintentional, self-harm-, and assault-related firearm injuries. Sociodemographic factors related to intent may be useful in guiding policy and informing tailored interventions for the prevention of firearm injuries in atrisk youth.

Relationships between socioeconomic deprivation and pediatric firearm-related injury at the neighborhood level

“…3 Inequities in the rates and nature of pediatric firearm-related injuries have been demonstrated based on sex, age, race, ethnicity, insurance status, and socioeconomic status (SES). There are much higher rates in males, [4][5][6][7][8][9][10][11][12][13][14][15] in older children and adolescents, [4][5][6]9,14,16 and disproportionately higher rates of firearm-and assault-related injury among Black and Hispanic children. 4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19] The most recent national data suggest that Black children account for 59.6% of all firearm-related hospitalizations and 66.8% of all firearm assault-related hospitalizations despite making up only 12.8% of the population.…”

“…6,20 Few studies have examined the impact of insurance, but those that have depict associations between public insurance, a proxy for lower SES, and hospitalization for firearm-related injury among children. 5,9 There is also an increased interest in understanding how a child's broader neighborhood context and neighborhood-level SDH, such as socioeconomic deprivation, may drive inequities in firearm-related injury. Several studies have examined links between area socioeconomic disadvantage or deprivation and pediatric firearm-related injury.…”

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

“…data reveals that only one-third of families who own guns report storing their firearms safely 12 and that unintentional injuries represent one-third of firearm injuries in American children, 13 typically occurring either in or close to home. 14 In contrast, only approximately 17%-34% of Canadian households own at least one firearm 15 and firearms are involved in 30% of homicides and 12% of suicides.…”

Taking Aim at the Injury Prevention Curriculum: Educating Residents on Talking to Patients About Firearm Injury

“…1 Unintentional firearm injuries and death are a particular risk among younger children. 3,4 Firearm homicide is a leading cause of death for teens and young adults aged 15–34, and the second leading cause of death for African American children 1 to 9 years of age. 1,5 Intimate partner violence is implicated in nearly 50% of killings of women by homicide, with firearms used in more than half of these homicides.…”