Gender Differences in Violent Penetrating Injuries and Long-Term Adverse Outcomes

Abstract

Violent injury is known to be a chronic, recurrent issue, with high rates of recidivism in the 5 years following initial injury. Much of the strategy behind violence intervention programs, who are tasked with reducing recidivism, is directed toward young men, while there has been little research into the unique risk factors or long-term outcomes for female victims of violence. The aim of this study was to examine the risk of violent injury and long-term adverse outcomes by gender. This retrospective study was performed using a cohort of 4337 patients presenting to the Boston Medical Center emergency department for a violent penetrating injury between 2006 and 2016. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for the risk of all-cause mortality and violent reinjury at 1 and 3 years after surviving a penetrating injury. There were 88 deaths (2.1%) and 568 violent reinjuries (13.2%) within 3 years after surviving the initial penetrating injury. At initial injury presentation, women were more likely to have a preexisting mental health diagnosis and to have been injured as a result of domestic violence. While men had greater than six times the risk of 3-year mortality compared to women (HR = 6.36, 95% CI = 1.56–25.83), both genders were equally at risk for violent reinjury (HR = 1.23, 95% CI = 0.95–1.59). Men were more likely to have a stab wound (HR = 2.68, 95% CI = 1.41–5.10) or gunshot wound (HR = 7.96, 95% CI = 2.95–21.48) reinjury, while women were more likely to have an assault (HR = 1.52, 95% CI = 1.13–2.04) or domestic violence (HR = 2.96, 95% CI = 1.43–6.12) reinjury. Compared to men, the risk of violent reinjury was significantly increased for women with a history of substance use disorders (p-interaction = 0.009). These results suggest a unique trifecta of risks for women—substance use, mental illness, and domestic violence—and underscore the critical role of violence intervention programs in addressing these risks to mitigate violent injury recidivism.