The Hidden Epidemic of Firearm Injury: Increasing Firearm Injury Rates During 2001–2013

Kalesan, Bindu; Adhikarla, Chandana; Pressley, Joyce C.; Fagan, Jeffrey; Xuan, Ziming; Siegel, Michael; Galea, Sandro

doi:10.1093/aje/kww147

Cited by 59 publications

(50 citation statements)

References 13 publications

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“…One report analyzed data from the Centers for Disease Control and Prevention combining annual counts of fatal and non-fatal firearm injury from 2002 to 2011 and concluded that firearm lethality was declining evidenced by stagnant rates for firearm homicide with rising rates of non-fatal firearm assault. 15 However, after correcting for facilities reporting to the sample, a separate analysis concluded that firearm lethality from assault has been constant from 2003 to 2012. 9 There is active debate on the merits and limitations of both approaches.…”

Section: Discussionmentioning

confidence: 99%

Trends in Firearm Injury and Motor Vehicle Crash Case Fatality by Age Group, 2003-2013

et al. 2019

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Importance: If changes over time in trauma care apply to both firearm injuries and motor vehicle crashes (MVC) similarly, differences in mechanism-specific case-fatality trends may suggest changes over time in injury severity. Objective: We analyzed national trends in case-fatality percentages at level I and II trauma centers for injuries due to MVC, firearm assault, self-inflicted firearm injury, and unintentional firearm injury by age. We also analyzed trends in injury severity scores (ISS) and the percentage of out-of-hospital deaths by mechanism. Design/Setting/Participants: We conducted a repeated cross-sectional measures analysis from 2003–2013 using two data sources: 1) the National Trauma Data Bank National Sample Program with survey weights to estimate annual median ISS, total injured and total died at level I and II trauma centers, and 2) the Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research for percentages of out-of-hospital deaths. Methods: We calculated annual case-fatality percentage (total died/total injured) by mechanism across three age groups: 1)15–34, 2) 35–54, and 3) ≥ 55, and five categories of ISS. We performed linear regression to estimate annual trends in case-fatality percentage by mechanism, age-group, and ISS. We estimated annual trends in percentages of out-of-hospital deaths and median ISS by mechanism. Sensitivity analyses included the Durbin-Watson statistic for autocorrelation and Prais-Winsten regression models. Results: Self-inflicted firearm injury and assault with a firearm had the two highest overall case-fatality percentages (42.8% and 11.1%, respectively). The injury case-fatality percentage was lower each year for MVC but did not change for any firearm intent overall, or for any age group. Overall, median ISS increased annually for firearm suicide (0.31 9%CI 0.00, 0.61). The annual percentage of out-of-hospital deaths was lower each year for MVCs (−0.24 95% CI −0.43, −0.05) but not for any firearm intents. In sensitivity analyses, the annual percentage of out-of-hospital deaths for MVC no longer showed a decline. Conclusions and Relevance: Stagnant case-fatality percentages for firearm injuries juxtaposed to improvements for MVCs across age-groups and ISS categories suggests worsening severity of firearm injuries over the study period.

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Section: Discussionmentioning

confidence: 99%

Trends in Firearm Injury and Motor Vehicle Crash Case Fatality by Age Group, 2003-2013

et al. 2019

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“…While the number of injuries far exceeds fatalities, state data regarding firearm injuries is neither comprehensive nor accessible. 4,7 Since most firearm injuries are nonfatal, many associations are unmeasurable when only fatalities are considered. A comprehensive database of all firearm injuries including fatalities would greatly facilitate future firearm injury research and prevention.…”

Section: Discussionmentioning

confidence: 99%

“…1,4 These injuries burden both the medical community and the American healthcare system with massive costs. In a recent report, Spitzer et al estimated the cost of initial hospitalizations alone for patients injured by firearms in America to be $734.6 million per year—a figure that multiplies to several billions when long-term medical care and employment loss are included.…”

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confidence: 99%

Firearm Deaths in America

et al. 2017

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Objective We sought to determine whether state firearm legislation correlated with firearm-related fatality rates (FFR) during a 15-year period. Background The politicized and controversial topic of firearm legislation has been grossly understudied when the relative impact of American firearm violence is considered. Scientific evidence regarding gun legislation effectiveness remains scant. Methods Demographic and intent data (1999–2013) were collected from the Centers for Disease Control and Prevention’s Web-Based Injury Statistics Query and Reporting System database and compared by state firearm legislation rankings with respect to FFR. State scorecards were obtained from firearm-restrictive (Brady Campaign/Law Center against Gun Violence [BC/LC]) and less-restrictive (National Rifle Association) groups. FFR were compared between restrictive and least-restrictive states during 3 periods (1999–2003, 2004–2008, 2009–2013). Results During 1999 to 2013, 462,043 Americans were killed by firearms. Overall FFR did not change during the 3 periods (10.89±3.99/100,000; 10.71±3.93/100,000; 11.14±3.91/100,000; P=0.87). Within each period, least-restrictive states had greater unintentional, pediatric, and adult suicide, White and overall FFR than restrictive states (all P<0.05). Conversely, no correlation was seen, during any of the 3 time periods, with either homicide or Black FFR—population subsets accounting for 41.7% of firearm deaths. Conclusions Restrictive firearm legislation is associated with decreased pediatric, unintentional, suicide, and overall FFR, but homicide and Black FFR appear unaffected. Future funding and research should be directed at both identifying the most effective aspects of firearm legislation and creating legislation that equally protects every segment of the American population.

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“…Data are collected by trained, onsite hospital coders who enter all elements of an encounter except cause of injury, which is classified by quality assurance coders at the Consumer Product Safety Commission headquarters in Bethesda, MD . This dataset has been used as the basis of many previous publications, including recent reports on traumatic brain injuries occurring at playgrounds, and trends in nonfatal firearm injuries …”

Section: Methodsmentioning

confidence: 99%

Unintentional Injuries in Primary and Secondary Schools in the United States, 2001‐2013

Zagel

Cutler

Linabery

et al. 2018

Journal of School Health

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BACKGROUND Unintentional injuries are the leading cause of youth morbidity. However, limited nationally representative data are available to characterize the occurrence of unintentional injuries at US schools. Given this paucity, we characterized secular trends in unintentional injuries at schools that led to emergency department (ED) visits. METHODS A retrospective analysis of the National Electronic Injury Surveillance System‐All Injury Program from 2001 to 2013 compared injuries occurring at schools to injuries occurring elsewhere in youth ages 5‐18 years. Incidence rates were calculated using weighted frequency estimates as numerators and US population estimates as denominators. RESULTS School injuries accounted for 21% of unintentional injury‐related ED visits, with an estimated annual incidence rate of 1385 injuries per 100,000 5‐ to 18‐year‐olds. Middle school‐aged youth (10‐13 years) had the highest annual incidence rate (1640 per 100,000 youth) compared with younger and older counterparts. School injuries were more likely to be due to sports/recreation than nonschool injuries (55% vs 41%, p < .0001). Importantly, no detectable change in incidence rates of school injuries between 2001 and 2013 was found (p = .11). CONCLUSIONS Stagnant annual incidence rates of unintentional injuries at schools and large numbers of school‐based injuries demonstrate that school‐based injuries are a notable opportunity for future prevention efforts.

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The Hidden Epidemic of Firearm Injury: Increasing Firearm Injury Rates During 2001–2013

Cited by 59 publications

References 13 publications

Trends in Firearm Injury and Motor Vehicle Crash Case Fatality by Age Group, 2003-2013

Trends in Firearm Injury and Motor Vehicle Crash Case Fatality by Age Group, 2003-2013

Firearm Deaths in America

Unintentional Injuries in Primary and Secondary Schools in the United States, 2001‐2013

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