Abstract
BackgroundFirearm violence is a public health problem that disparately impacts areas of economic and social deprivation. Despite a growing literature on neighborhood characteristics and injury, few studies have examined the association between neighborhood disadvantage and fatal and nonfatal firearm assault using data on injury location. We conducted an ecological Bayesian spatial analysis examining neighborhood disadvantage as a social determinant of firearm injury in Seattle, Washington.MethodsNeighborhood disadvantage was measured using the National Neighborhood Data Archive disadvantage index. The index includes proportion of female-headed households with children, proportion of households with public assistance income, proportion of people with income below poverty in the past 12 months, and proportion of the civilian labor force aged 16 and older that are unemployed at the census tract level. Firearm injury counts included individuals with a documented assault-related gunshot wound identified from medical records and supplemented with the Gun Violence Archive between March 20, 2016 and December 31, 2018. Available addresses were geocoded to identify their point locations and then aggregated to the census tract level. Besag-York-Mollie (BYM2) Bayesian Poisson models were fit to the data to estimate the association between the index of neighborhood disadvantage and firearm injury count with a population offset within each census tract.ResultsNeighborhood disadvantage was significantly associated with the count of firearm injury in both non-spatial and spatial models. For two census tracts that differed by 1 decile of neighborhood disadvantage, the number of firearm injuries was higher by 21.0% (95% credible interval: 10.5, 32.8%) in the group with higher neighborhood disadvantage. After accounting for spatial structure, there was still considerable residual spatial dependence with 53.3% (95% credible interval: 17.0, 87.3%) of the model variance being spatial. Additionally, we observed census tracts with higher disadvantage and lower count of firearm injury in communities with proximity to employment opportunities and targeted redevelopment, suggesting other contextual protective factors.ConclusionsEven after adjusting for socioeconomic factors, firearm injury research should investigate spatial clustering as independence cannot be able to be assumed. Future research should continue to examine potential contextual and environmental neighborhood determinants that could impact firearm injuries in urban communities.
Highlights
Firearm violence is a public health problem that disparately impacts areas of economic and social deprivation
Considering firearm violence using a public health framework may identify structural risk factors to facilitate longer-term effects compared to interventions that solely focus on high-risk individuals (Branas et al, 2017)
From March 20, 2016 through December 31, 2018, there were 219 firearm assault injuries identified in Seattle of which 191 were able to be geocoded by place of occurrence (87.2%)
Summary
Firearm violence is a public health problem that disparately impacts areas of economic and social deprivation. We conducted an ecological Bayesian spatial analysis examining neighborhood disadvantage as a social determinant of firearm injury in Seattle, Washington. Firearm violence displays a marked geographic distribution concentrated in certain areas of notable economic and social disparities. Researchers have been examining the connection between deprivation and violence for decades, using various measures of neighborhood disadvantage and violence such as violent crime (Baumer et al, 2003; Hsieh & Pugh, 1993; Lauritsen & White, 2001), and homicide (Jones-Webb & Wall, 2008). Measures of poverty and disadvantage including income inequality (Rowhani-Rahbar et al, 2019), social capital, social mobility, and local welfare spending (Kim, 2019) have been found to be associated with firearm homicide across the United States. As fatality often depends on the anatomical area of injury (Beaman et al, 2000) and distance from trauma centers (Circo, 2019), relying on fatal firearm injury only may provide an incomplete understanding of the determinants of firearm injury
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