Firearm Mortality Research Articles

Prevention of Firearm Injury through Policy and Law: The Social Ecological Model.

Rates of firearm injury and mortality are far higher in the United States compared to other high-income nations. Patterns of firearm injury have complex causal pathways; different social contexts may be differentially affected by firearm legislation. In the context of the diversity of social, political, and legal approaches at the state level, we suggest the application of the social ecological model as a conceptual public health framework to guide future policy interventions in the U.S.

Wounded adolescences: a portrait of firearm violence reported in Brazil.

To describe the notifications of interpersonal and self-inflicted firearm violence in adolescents and to identify the factors associated with the notification of this event. Cross-sectional study analyzing data from Sinan from 2011 to 2017, in adolescents aged 10-19 years, injured by firearms. The χ2 test was used to verify the gender ratio difference. Correlation analysis and multiple linear regression were performed between the logarithm of the firearm notification rate and each independent variable, in a sample of large municipalities. There were 30,103 reports of firearm violence in adolescents, of which (74.7%) were males aged 15-19 years (83.8%). Among girls, violence is more common at home, with a known perpetrator, and with physical and sexual violence combined. The death rate by firearms was higher in Fortaleza, Maceió, João Pessoa, Salvador and Natal, ranging from 105.88 to 71.73 per 100 thousand. Higher notification rates of firearm violence were associated with higher firearm death rates and greater coverage of health facilities. Firearm violence is a major public health problem in adolescents. Attacks on the disarmament statute and the loosening of gun possession and ownership directly confront the present and future of children and adolescents.

Pediatric firearm mortality in the United States, 2010 to 2016: A National Trauma Data Bank analysis.

Pediatric firearm injury is a leading cause of death for U.S. children. We sought to further characterize children who die from these injuries using a validated national database. The National Trauma Data Bank 2010 to 2016 was queried for patients aged 0 to 19 years old. International Classification of Diseases external cause of injury codes were used to classify patients by intent. Differences between groups were analyzed using χ or Mann-Whitney U tests. Patterns over time were analyzed using nonparametric tests for trend. Multivariable logistic regression was used to investigate associations between the above factors and mortality. There were a total of 45,288 children with firearm injuries, 12.0% (n = 5,412) of whom died. Those who died were younger and more often white than survivors. Mortality was associated with increased injury severity, shock on presentation, and polytrauma (p < 0.001 for all). There was an increasing trend in the proportion of self-inflicted injuries over the study period (p < 0.001), and mortality from these self-inflicted injuries increased concordantly (35.3% in 2010 to 47.8% in 2016, p = 0.001). Location of severe injuries had significant different mortality rates, ranging from 51.3% of head injuries to 3.9% in the extremities. In the multivariable model, treatment at a pediatric trauma center was protective against mortality, with odds ratios of 2.10 (confidence interval, 1.64-2.68) and 1.80 (confidence interval, 1.39-2.32) for death at adult and dual-designated trauma centers, respectively. This finding was confirmed in age-stratified cohorts. Proportions of self-inflicted pediatric firearm injury in the National Trauma Data Bank increased from 2010 to 2016, as did mortality from self-inflicted injury. Because mortality is highest in this subpopulation, prevention and treatment efforts should be prioritized in this group of firearm-injured children. Epidemiological study, level V.

APA Joins in Call for Funding For Firearms Research

Back to table of contents Previous article Next article Government & LegalFull AccessAPA Joins in Call for Funding For Firearms ResearchKatie O’ConnorKatie O’ConnorSearch for more papers by this authorPublished Online:2 Dec 2019https://doi.org/10.1176/appi.pn.2019.12a19AbstractThough it is the second leading cause of death among children and adolescents, firearm injury prevention receives a fraction of the funding allotted to other leading causes of death.Citing the public health concern presented by firearm violence, APA and five other medical organizations wrote a letter to key members of Congress asking them to include $50 million in funding for research on preventing firearm-related morbidity and mortality in their final appropriations package.“Federally funded public health research has played a significant role in addressing other public health crises such as youth smoking and motor vehicle crashes,” wrote APA and its five partner organizations: the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American Osteopathic Association.“We need to apply the same rigorous scientific approach to reducing injuries and deaths associated with firearms,” the letter continued. Known as the Group of Six, the organizations represent over 590,000 frontline physicians and medical students.The organizations applauded the House for including $50 million for firearm-related, public health research in its appropriations legislation but asked House Speaker Nancy Pelosi (D-Calif.), House Minority Leader Kevin McCarthy (R-Calif.), Senate Minority Leader Charles Schumer (D-New York), and Senate Majority Leader Mitch McConnell (R-Kentucky) to also include the funding in any final appropriations package.Over 39,000 people died in 2017 due to firearm-related injuries, according to the letter. Two-thirds of gun-related deaths are suicide deaths.“The United States is one of the only countries in the world with a rising rate of suicide,” said APA President Bruce Schwartz, M.D. “Congress must act decisively to reverse this trend.”“Suicide is the 10th leading cause of death overall in the United States and the second leading cause of death for young adults,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “We need to dedicate research dollars to achieve a better understanding of this epidemic and prevent firearm-associated deaths.”A study published in Health Affairs in October analyzed the federal research dollars devoted to the leading causes of death for children and adolescents from 2008 to 2017. Cancer, the third-leading cause, received $335 million a year, while motor vehicle crashes, the number one cause, received $88 million. Though firearm injury is the second leading cause of death in this age group, it received only $12 million a year, “averaging $597 in research dollars per death,” the study found.“Pediatric firearm injury prevention is substantially underfunded in relation to the magnitude of the public health problem,” wrote lead author Rebecca Cunningham, M.D., a professor in the Department of Emergency Medicine at the University of Michigan School of Medicine, and colleagues. “According to our analysis, federal funding for this leading cause of pediatric mortality is 3.3% of what is needed for it to be commensurate with the funding for other common causes of pediatric death.”The Group of Six letter pointed out that both the Centers for Disease Control and Prevention and the National Institutes of Health are well placed to conduct research on firearm mortality. With $50 million, researchers at the agencies “could conduct 10 to 20 new, large, multiyear studies each year,” the groups wrote.“With this research,” they continued, “we will be able to better understand and quantify the scope, root causes, and impact of gun violence and identify opportunities to reduce injuries and fatalities.” ■ ISSUES NewArchived

Changes in patterns of mortality rates and years of life lost due to firearms in the United States, 1999 to 2016: A joinpoint analysis.

BackgroundFirearm-related death rates and years of potential life lost (YPLL) vary widely between population subgroups and states. However, changes or inflections in temporal trends within subgroups and states are not fully documented. We assessed temporal patterns and inflections in the rates of firearm deaths and %YPLL due to firearms for overall and by sex, age, race/ethnicity, intent, and states in the United States between 1999 and 2016.MethodsWe extracted age-adjusted firearm mortality and YPLL rates per 100,000, and %YPLL from 1999 to 2016 by using the WONDER (Wide-ranging Online Data for Epidemiologic Research) database. We used Joinpoint Regression to assess temporal trends, the inflection points, and annual percentage change (APC) from 1999 to 2016.ResultsNational firearm mortality rates were 10.3 and 11.8 per 100,000 in 1999 and 2016, with two distinct segments; a plateau until 2014 followed by an increase of APC = 7.2% (95% CI 3.1, 11.4). YPLL rates were from 304.7 and 338.2 in 1999 and 2016 with a steady APC increase in %YPLL of 0.65% (95% CI 0.43, 0.87) from 1999 to an inflection point in 2014, followed by a larger APC in %YPLL of 5.1% (95% CI 0.1, 10.4). The upward trend in firearm mortality and YPLL rates starting in 2014 was observed in subgroups of male, non-Hispanic blacks, Hispanic whites and for firearm assaults. The inflection points for firearm mortality and YPLL rates also varied across states.ConclusionsWithin the United States, firearm mortality rates and YPLL remained constant between 1999 and 2014 and has been increasing subsequently. There was, however, an increase in firearm mortality rates in several subgroups and individual states earlier than 2014.

Long-term Functional, Psychological, Emotional, and Social Outcomes in Survivors of Firearm Injuries

The outcomes of firearm injuries in the United States are devastating. Although firearm mortality and costs have been investigated, the long-term outcomes after surviving a gunshot wound (GSW) remain unstudied. To determine the long-term functional, psychological, emotional, and social outcomes among survivors of firearm injuries. This prospective cohort study assessed patient-reported outcomes among GSW survivors from January 1, 2008, through December 31, 2017, at a single urban level I trauma center. Attempts were made to contact all adult patients (aged ≥18 years) discharged alive during the study period. A total of 3088 patients were identified; 516 (16.7%) who died during hospitalization and 45 (1.5%) who died after discharge were excluded. Telephone contact was made with 263 (10.4%) of the remaining patients, and 80 (30.4%) declined study participation. The final study sample consisted of 183 participants. Data were analyzed from June 1, 2018, through June 20, 2019. A GSW sustained from January 1, 2008, through December 31, 2017. Scores on 8 Patient-Reported Outcomes Measurement Information System (PROMIS) instruments (Global Physical Health, Global Mental Health, Physical Function, Emotional Support, Ability to Participate in Social Roles and Activities, Pain Intensity, Alcohol Use, and Severity of Substance Use) and the Primary Care PTSD (posttraumatic stress disorder) Screen for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Of the 263 patients who survived a GSW and were contacted, 183 (69.6%) participated. Participants were more likely to be admitted to the hospital compared with those who declined (150 [82.0%] vs 54 [67.5%]; P = .01). Participants had a median time from GSW of 5.9 years (range, 4.7-8.1 years) and were primarily young (median age, 27 years [range, 21-36 years]), black (168 [91.8%]), male (169 [92.3%]), and employed before GSW (pre-GSW, 139 [76.0%]; post-GSW, 113 [62.1%]; decrease, 14.3%; P = .004). Combined alcohol and substance use increased by 13.2% (pre-GSW use, 56 [30.8%]; post-GSW use, 80 [44.0%]). Participants had mean (SD) scores below population norms (50 [10]) for Global Physical Health (45 [11]; P < .001), Global Mental Health (48 [11]; P = .03), and Physical Function (45 [12]; P < .001) PROMIS metrics. Eighty-nine participants (48.6%) had a positive screen for probable PTSD. Patients who required intensive care unit admission (n = 64) had worse mean (SD) Physical Function scores (42 [13] vs 46 [11]; P = .045) than those not requiring the intensive care unit. Survivors no more than 5 years after injury had greater PTSD risk (38 of 63 [60.3%] vs 51 of 119 [42.9%]; P = .03) but better mean (SD) Global Physical Health scores (47 [11] vs 43 [11]; P = .04) than those more than 5 years after injury. This study's results suggest that the lasting effects of firearm injury reach far beyond mortality and economic burden. Survivors of GSWs may have negative outcomes for years after injury. These findings suggest that early identification and initiation of long-term longitudinal care is paramount.

Civilian Concealed Carry Legislation and Unintentional Firearm Mortality in the US: 1986–2015

Civilian Concealed Carry Legislation and Unintentional Firearm Mortality in the US: 1986–2015

US Firearm-Related Mortality: National, State, And Population Trends, 1999-2017.

Nationwide firearm-related mortality rates increased in 2015-17 after remaining relatively stable in 1999-2014. Recent increases are reflected across most states and demographics to varying degrees, which suggests a worsening epidemic of firearm mortality that is geographically and demographically broad. In both time periods the fractions of firearm deaths due to suicide and homicide remained consistent.

The impact of spikes in handgun acquisitions on firearm-related harms

BackgroundResearch has documented sharp and short-lived increases in firearm acquisitions immediately following high-profile mass shootings and specific elections, increasing exposure to firearms at the community level. We exploit cross-city variation in the estimated number of excess handgun acquisitions in California following the 2012 presidential election and the Sandy Hook school shooting 5 weeks later to assess whether the additional handguns were associated with increases in the rate of firearm-related harms at the city level.MethodsWe use a two-stage modeling approach. First, we estimate excess handguns as the difference between actual handgun acquisitions, as recorded in California’s Dealer Record of Sales, and expected acquisitions, as predicted by a seasonal autoregressive integrated moving-average (SARIMA) time series model. We use Poisson regression models to estimate the effect of city-level excess handgun purchasing on city-level changes in rates of firearm mortality and injury.ResultsWe estimate there were 36,142 excess handguns acquired in California in the 11 weeks following the election (95% prediction interval: 22,780 to 49,505); the Sandy Hook shooting occurred in week 6. We find city-level purchasing spikes were associated with higher rates of firearm injury in the 52 weeks post-election: a relative rate of 1.044 firearm injuries for each excess handgun per 1,000 people (95% CI: 1.000 to 1.089). This amounts to approximately 290 (95% CI: 0 to 616) additional firearm injuries (roughly a 4% increase) in California over the year. We do not detect statistically significant associations for shorter time windows or for firearm mortality.ConclusionThis study provides evidence for an association between excess handgun acquisitions following high-profile events and firearm injury at the community level. This suggests that even marginal increases in handgun prevalence may be impactful.

Pediatric Firearm-Related Traumatic Brain Injury in United States Trauma Centers

Abstract INTRODUCTION Firearm injury is a leading cause of death and disability in the American youth. Epidemiology and outcomes following gunshot wound to the head (GSWH) are in need of systematic characterization. Here, we analyzed pediatric GSWH to identify predictors of prolonged hospitalization, morbidity and mortality. METHODS All patients &lt; 18 yr with GSWH in the National Sample Program (NSP) of the National Trauma Data Bank (NTDB) from 2003 to 2012 were identified. Variables included injury intent, firearm choice, injury site, age, sex, race, health insurance, geographic region, trauma center level, isolated TBI, emergency department (ED) hypotension, Glasgow Coma Scale (GCS), and Injury Severity Score (ISS). Outcomes were hospital length of stay (HLOS), morbidity and mortality. Odds ratios (OR), mean increase/decrease (B), and 95% confidence intervals (CI) were reported. Statistical significance was assessed at a &lt; 0.001 accounting for multiple comparisons. RESULTS In a weighted sample of 2847 pediatric GSWHs, age was 14.8 ± 3.3 yr, 79.2% were male, and 59.0% had severe traumatic brain injury (TBI; Glasgow Coma Scale [GCS] score 3-8). Assault (63.0%), handgun as firearm (45.6%), and injury in residential areas (40.6%) were most common. HLOS was 11.6 ± 14.4 d for the survivors, for which suicide injuries had longer hospitalization (B = 5.9 day increase, 95% CI [3.3-8.6], P &lt; .001) relative to accidents. The overall mortality was 45.1%, and was greater with suicide intent (mortality = 71.5%, P &lt; .001) and shotgun as firearm (mortality = 56.5%, P &lt; .001). Lower GCS, higher ISS, and hypotension predicted poorer outcomes. Management at level II centers was associated with lower odds of returning home (OR = 0.3, [0.2-0.5], P &lt; .001). CONCLUSION From 2003 to 2012, the proportion of accidental injuries decreased while suicides increased. The overall mortality was 45%, with hypotension, cranial and overall injury severity, and suicide intent being associated with poor prognosis. Patients treated at level II trauma centers had lower odds of being discharged home. Improved risk screening, parental education and standardization of critical care management are needed.

State of the science: a scoping review of primary prevention of firearm injuries among children and adolescents.

Intentional and unintentional firearm injury is the second leading cause of death for youth, underscoring the need for effective primary prevention approaches that focus on increasing safe storage by caregivers and decreasing handling/carriage among youth. This article describes the state of the science for prevention of firearm injuries among children and adolescents. We applied PRISMA guidelines to present results from a scoping review using PubMed, Scopus, CINAHL, and CJ Abstracts for original research articles published between January 1, 1985 and March 1, 2018 in the U.S. focusing on primary screening or interventions for primary prevention of pediatric firearm injuries. In total, 46 articles met inclusion criteria: safe storage (23), screening (2), firearm handling/carriage/use (21). Across school, healthcare, and community settings, few evidenced-based programs exist, and data on firearm safety technologies are lacking. Programs have generally not employed rigorous designs, and/or assessed behavioral (e.g., carriage) or injury-related firearm outcomes. Evidenced-based prevention programs are needed to mitigate firearm morbidity and mortality among youth.

Firearm Ownership and Domestic Versus Nondomestic Homicide in the U.S.

Gun ownership is associated with firearm mortality, although this association differs across victim-offender relationships. This study examines the relationship between gun ownership and domestic versus nondomestic homicide rates by victim sex. Several sources of state-level panel data from 1990 through 2016 were merged from each of the 50 states to model domestic (i.e., family and intimate partners) and nondomestic firearm homicide as a function of state-level household firearm ownership. Firearm ownership was examined using a validated proxy measure and homicide rates came from the Supplemental Homicide Reports of the Federal Bureau of Investigation's Uniform Crime Reports. Negative binomial regression with fixed effects was used to model the outcomes and employed generalized estimating equations to account for clustering within states. Statistical analyses were completed in 2018. State-level firearm ownership was uniquely associated with domestic (incidence rate ratio=1.013, 95% CI=1.008, 1.018) but not nondomestic (incidence rate ratio=1.002, 95% CI=0.996, 1.008) firearm homicide rates, and this pattern held for both male and female victims. States in the top quartile of firearm ownership had a 64.6% (p<0.001) higher incidence rate of domestic firearm homicide than states in the lowest quartile; however, states in the top quartile did not differ significantly from states in the lowest quartile of firearm ownership in observed incidence rates of nondomestic firearm homicide. State-level firearm ownership rates are related to rates of domestic but not nondomestic firearm homicide.

Geospatial, racial, and educational variation in firearm mortality in the USA, Mexico, Brazil, and Colombia, 1990–2015: a comparative analysis of vital statistics data

Firearm mortality is a leading, and largely avoidable, cause of death in the USA, Mexico, Brazil, and Colombia. We aimed to assess the changes over time and demographic determinants of firearm deaths in these four countries between 1990 and 2015. In this comparative analysis of firearm mortality, we examined national vital statistics data from 1990-2015 from four publicly available data repositories in the USA, Mexico, Brazil, and Colombia. We extracted medically-certified deaths and underlying population denominators to calculate the age-specific and sex-specific firearm deaths and the risk of firearm mortality at the national and subnational level, by education for all four countries, and by race or ethnicity for the USA and Brazil. Analyses were stratified by intent (homicide, suicide, unintentional, or undetermined). We quantified avoidable mortality for each country using the lowest number of subnational age-specific and period-specific death rates. Between 1990 and 2015, 106·3 million medically-certified deaths were recorded, including 2 472 000 firearm deaths, of which 851 000 occurred in the USA, 272 000 in Mexico, 855 000 in Brazil, and 494 000 in Colombia. Homicides accounted for most of the firearm deaths in Mexico (225 000 [82·7%]), Colombia (463 000 [93·8%]), and Brazil (766 000 [89·5%]). Suicide accounted for more than half of all firearm deaths in the USA (479 000 [56·3%]). In each country, firearm mortality was highest among men aged 15-34 years, accounting for up to half of the total risk of death in that age group. During the study period, firearm mortality risks increased in Mexico and Brazil but decreased in the USA and Colombia, with marked national and subnational geographical variation. Young men with low educational attainment were at increased risk of firearm homicide in all four countries, and in the USA and Brazil, black and brown men, respectively, were at the highest risk. The risk of firearm homicide was 14 times higher in black men in the USA aged 25-34 years with low educational attainment than comparably-educated white men (1·52% [99% CI 1·50-1·54] vs 0·11% [0·10-0·12]), and up to four times higher than in comparably-educated men in Brazil, Colombia, and Mexico. In the USA, the risk of firearm homicide was more than 30 times higher in black men with post-secondary education than comparably educated white men. If countries could achieve the same firearm mortality rates nationally as in their lowest-burden states, 1 777 800 firearm deaths at all ages and in both sexes could be avoided, including 1 028 000 deaths in men aged 15-34 years. Firearm mortality in the USA, Mexico, Brazil, and Colombia is highest among young adult men, and is strongly associated with race and ethnicity, and low education levels. Reductions in firearm deaths would improve life expectancy, particularly for black men in the USA, and would reduce racial and educational disparities in mortality. Canadian Institutes of Health Research and the University of Toronto Connaught Global Challenge.

Association of Increased Safe Household Firearm Storage With Firearm Suicide and Unintentional Death Among US Youths

Firearm injury is the second leading cause of death in the United States for children and young adults. The risk of unintentional and self-inflicted firearm injury is lower when all household firearms are stored locked. To estimate the reduction in youth firearm suicide and unintentional firearm mortality that would result if more adults in households with youth stored household guns locked. A modeling study using Monte Carlo simulation of youth firearm suicide and unintentional firearm mortality in 2015. A simulated US national sample of firearm-owning households where youth reside was derived using nationally representative rates of firearm ownership and storage and population data from the US Census to test a hypothetical intervention, safe storage of firearms in the home, on youth accidental death and suicide. Data analyses were performed from August 3, 2017, to January 9, 2018. Observed and counterfactual household-level safe firearm storage (ie, storing all firearms locked), the latter estimated by varying the probability that a hypothetical intervention increased safe firearm storage beyond that observed in 2015. Observed and counterfactual counts of firearm suicide and unintentional firearm mortality among youth aged 0 to 19 years, the latter estimated by incorporating an empirically based estimate of the mortality benefit expected from additional safe storage (beyond that observed in 2015). A hypothetical intervention among firearm owners residing with children with a 20% probability of motivating these owners to lock all household firearms was significantly associated with a projected reduction in youth firearm mortality (median incidence rate ratio = 0.90; interquartile range, 0.87-0.93). In the overall model, 6% to 32% of deaths were estimated to be preventable depending on the probability of motivating safer storage. Results of this modeling study suggest that a relatively modest uptake of a straightforward safe storage recommendation-lock all household firearms-could result in meaningful reductions in firearm suicide and unintentional firearm fatalities among youth. Approaches that will motivate additional parents to store firearms safely are needed.

American firearm homicides: The impact of your neighbors.

Restrictive firearm legislation has correlated with decreased overall firearm fatality rates, but not with firearm-related homicide or firearm mortality among Black Americans. We hypothesized that firearm trafficking from states with less restrictive firearm legislation to neighboring states with more restrictive firearm legislation increases firearm homicide rates in those restrictive states. For years 2011-2015, state firearm legislation Brady Campaign to Prevent Gun Violence scorecards were analyzed in relation to firearms traced by the Bureau of Alcohol, Tobacco, and Firearms and Center for Disease Control and Prevention firearm mortality rates. States were ranked by Brady score and arranged by quintile to establish the Standardized Brady Score. The effect of less-restrictive neighboring states on the 10 most-restrictive firearm legislation states was modeled by averaging the 10 most-restrictive states with their bordering states to create a Border Adjustment Score. Firearm fatality rates were calculated for each quintile and Poisson regression models were created for each score and outcome. Model fit was compared using Akaike Information Criterion (AIC). There were 169,396 firearm fatalities including 57,885 firearm homicides. Comparing top and bottom quintile firearm legislation states, 65% vs. 44% of firearms traced by the Bureau of Alcohol, Tobacco, Firearms and Explosives originated in other states respectively. The Border Adjustment Score generated a more linear relationship than the Standardized Brady Score for all firearm fatality categories as firearm legislation scores decreased. The Border Adjustment Score minimized the AIC with respect to the Standardized Brady Score for black (AIC, 4443 vs. 4680) and white firearm homicide rates (3243 vs. 4319), indicating improved model fit after adjustment for neighboring state firearm legislation. Our results suggest that firearm movement across states plays an important role in firearm homicides. Accounting for firearm legislation in both individual and neighboring states may improve our understanding of the relationship between firearm legislation and homicide. Prognostic and epidemiological study, level IV.

Pediatric firearm incidents: It is time to decrease on-scene mortality.

Previous epidemiological studies on pediatric firearm mortality have focused on overall mortality rather than on-scene mortality. Despite advances in trauma care, the number of potentially preventable deaths remains high. This study used the National Emergency Medical Services Information Systems database to characterize patterns of on-scene mortality in order to identify patients who may benefit from changes to prehospital care practices. National Emergency Medical Services Information Systems database was searched for all pediatric firearm incidents from 2010 to 2015. Data on demographics, anatomic location of injury, intent and location of incident, and on-scene mortality were analyzed using Student's t test for continuous variables and χ test for categorical variables. A linear regression model was used to calculate independent predictors of mortality. Sixteen thousand eight hundred eight patients were identified, with a mortality rate of 6.1%. Most mortalities suffered cardiac arrest on-scene; 72.6% of these were prior to Emergency Medical Services (EMS) arrival, which carried a significantly higher mortality rate than arrest after EMS arrival. No difference was seen in anatomic location of injury in those who arrested before and after EMS arrival. Compressible injuries were most common with the lowest mortality. Noncompressible injuries together accounted for 25.8% of injuries and 23.5% of mortalities. To our knowledge, this is the largest study of on-scene mortality in pediatric firearm injury. Cardiac arrest prior to EMS arrival was a considerable source of on-scene mortality; significantly more of these patients died than those who arrested after EMS arrival. The mortality of compressible injuries was very low, implying that use of compression and tourniquets have been effective in stopping life-threatening extremity bleeding. Noncompressible injury mortality could be decreased with education of bystanders and more aggressive on-scene intervention. Through the evaluation of on-scene mortality specifically, this study offers insight into potential areas of focus to improve prehospital care of pediatric gunshot victims. Therapeutic/Care management, level IV.

Firearm Legislation Stringency and Firearm-Related Fatalities among Children in the US

Firearm-related injuries are the second leading cause of pediatric deaths in the US. We sought to evaluate the effectiveness of both state child access prevention (CAP) laws and gun regulations on pediatric firearm mortality. We hypothesized that states with more stringent firearm legislation had lower pediatric firearm mortality. We used 2014-2015 firearm mortality data from the Web-Based Injury Statistics Query and Reporting System, 2014 Brady scores (used to quantify stringency of state gun regulations) and CAP laws. State-level covariates were obtained from government sources, including the Bureau of Labor Statistics and the Department of Education. Spearman rank correlations and linear regression were used to determine the relationship between overall pediatric firearm mortality and gun regulations. We also examined the relationship between gun regulations and firearm-related homicides and suicides. Annually, there were approximately 2,715 pediatric firearm fatalities among children; 62.1% were homicides and 31.4% suicides. There was a moderate negative correlation between states' firearm legislation stringency and overall pediatric firearm mortality (ρ=-0.66; p < 0.001), and between CAP laws and firearm suicide rates (ρ=-0.56; p < 0.001). After controlling for poverty, unemployment, substance abuse, and the number of registered firearms, the association between firearm legislation stringency and overall pediatric firearm mortality remained significant (p= 0.04). The association between CAP laws and firearm suicide rate remained significant after controlling for socioeconomic factors, registered firearms, and other firearm legislation (p= 0.04). Strict gun legislation and CAP laws are associated with fewer pediatric firearm fatalities and firearm suicides, respectively, though no such association was identified with pediatric firearm homicides. Although more studies are needed to determine causality, state-level legislation could play an important role in reducing pediatric firearm-related deaths.

Rising U.S. Youth Death Rate From Car Crashes, Firearms Called ‘Shameful’

Back to table of contents Previous article Next article Professional NewsFull AccessRising U.S. Youth Death Rate From Car Crashes, Firearms Called ‘Shameful’Linda M. RichmondLinda M. RichmondSearch for more papers by this authorPublished Online:26 Feb 2019https://doi.org/10.1176/appi.pn.2019.2a12AbstractThe U.S. death rate is rising for children and adolescents from motor vehicle crashes, suicides, gunshots, drug overdose or poisoning, and other causes. Leadership from the medical and public health communities is needed to reverse this tragic trend.A child or adolescent in the United States is far more likely to die from motor vehicle crashes or gunshots than in any other high-income country in the world, according to an analysis posted December 20, 2018, in the New England Journal of Medicine. The analysis was based on the most recent data from the Centers for Disease Control and Prevention.iStock/deepblue4youThe motor vehicle accident death rate among U.S. children and adolescents has been cut in half in the past 20 years, mostly due to widespread adoption of seat belts and car safety seats. Yet it is more than triple the rate in other high-income countries (5.21 deaths per 100,000 versus 1.63 deaths per 100,000), according to the report by Rebecca M. Cunningham, M.D., a professor of emergency medicine and director of the Injury Prevention Center at the University of Michigan Medical School, and colleagues.As for firearm deaths, the rate of gunshot deaths among youth was higher in the United States than all other countries—both high income and low/middle income—with available 2016 data. In fact, U.S. youth were 37 times more likely to be killed by firearms than in 12 other high-income countries (4.02 deaths per 100,000 versus 0.11 per 100,000). Researchers attributed this to high rates of gun ownership and lax laws governing purchase, access, and storage.“Children in America are dying or being killed at rates that are shameful,” wrote Edward W. Campion, M.D., in an accompanying editorial. “Both individuals and the larger society need to understand that there is much that can be done to reduce the rate of fatal trauma. Strong leadership by the medical and public health communities is needed. Education, awareness, and very feasible interventions can help protect children and adolescents.”In fact, youth in the United States are 57 percent more likely to die by age 19 than those in other wealthy nations, Campion wrote. “The death of a child is a crime against nature,” he added. “These tragedies leave enduring pain and may be the most stressful thing that can happen to parents and siblings. The devastated families take no comfort from the fact that childhood deaths are now far less common than they were in centuries past.” He concluded that the United States is clearly not protecting its children.In all, there were more than 20,300 deaths among children and adolescents in the United States in 2016, the most recent year for which data are available, and the majority—60 percent—resulted from injury-related causes. U.S. medical advances in treating infectious disease and cancer have been eclipsed by increasing deaths from injury-related causes, including motor vehicle crashes, firearm injuries, and the emerging problem of opioid overdoses, Cunningham and colleagues wrote.Although many of these deaths are viewed as accidents, Cunningham and colleagues noted that “injury prevention science increasingly shows that such deaths are preventable with evidence-based approaches.” Motor vehicle crashes were the leading cause of death for children and adolescents in the United States, representing 20 percent of all deaths, followed by firearm-related injuries (15 percent) and malignant neoplasm (9 percent).Since 2013, motor vehicle crash deaths have been on the rise among youth, possibly due to an increase in distracted driving because of cell phones and peer passengers, authors noted.Youth deaths by firearm-related injury were near a 20-year high; in fact, there was a 28 percent increase in the rate of firearm deaths between 2013 and 2016. More than one-third of youth firearm deaths were suicides, a 26 percent increase between 2013 and 2016. Meanwhile, the rate of suicide by other means increased 15 percent.Researchers found drug overdoses or poisoning made up nearly 5 percent of youth deaths in 2016, and the vast majority (78 percent) were unintentional.The report noted racial and ethnic disparities in youth deaths in the United States. Youth mortality was highest among blacks (38 deaths per 100,000) and American Indian or Alaska natives (28 per 100,000) compared with whites (24 per 100,000). The disparities were most pronounced for firearm-related deaths, which were the leading cause of death among black youth and occurred at a rate nearly four times higher than the rate among white youth. ■“The Major Causes of Death in Children and Adolescents in the United States” can be accessed here. The accompanying editorial, “The Problem for Children in America,” is available here. ISSUES NewArchived

Macroeconomic burden of firearm-related fatality across OECD countries: an estimate of annual and cumulative gross domestic product losses, 2018–30

Abstract Background In 2015, firearm-related unintentional injuries, physical violence, and self-harm caused over 36 000 deaths and 100 000 injuries in the USA, and over 250 000 deaths worldwide. Of these deaths, more than 64 000 were in OECD countries. Nevertheless, firearm injury risk reduction remains socially and politically controversial. Although the costs of treating firearm injuries has been estimated, little is known about the macroeconomic impact of firearm deaths. Here, we aim to estimate the future macroeconomic burden of deaths in OECD countries. Methods Using value-of-lost-output methodology, which estimates the macroeconomic burden of deaths in terms of lost economic productivity, we estimated the annual and cumulative gross domestic product (GDP) lost due to firearm-related fatalities from 2018 to 2030 in all 36 OECD countries. We used mortality data from the 2016 Global Burden of Disease study to project mortality rates from 2018 to 2030. We then applied these projections to an adapted version of the WHO EPIC (Projecting the Economic Cost of Ill-health) model to project GDP losses attributable to firearm-related deaths. Findings Across OECD countries, we estimated macroeconomic losses from firearm mortality at US$272·1 billion in lost economic output between 2018 and 2030 ($124·9 billion from physical violence, $135·7 billion from self-harm, and $11·4 billion from unintentional injury), with $8·0 billion in annual losses in 2018 growing to an estimated loss of $35·9 billion in 2030. This amount represents 0·051% of total estimated 2030 GDP, or $1 lost for every $1944 of potential economic output. The USA is estimated to lose more than other OECD nations, with annual GDP losses of $24·5 billion in 2030, representing 0·10% of US GDP in 2030, and $180·6 billion cumulative losses from 2018 to 2030. Mexico's estimated loss in 2030 is $6·3 billion, which represents 0·20% of Mexican GDP in 2030, and $50·3 billion cumulatively from 2018 to 2030. No other OECD country had estimated cumulative losses greater than $10·6 billion in the study period, nor greater than 0·04% of GDP in 2030. Considered as a proportion of 2030 GDP, the USA's projected losses were 93·0% higher and Mexico's losses were 290·6% higher than the mean proportional losses across all OECD countries in 2030. Interpretation Firearm-related deaths are expected to cause disproportionately high macroeconomic losses in the USA and Mexico from 2018 to 2030 compared with other OECD countries. These losses represent an important proportion of GDP, and should be considered in broader social, economic, and health policy decisions about firearm regulation. Future studies might consider cost-benefit analyses that weigh the costs of risk reduction interventions against the potential economic savings of reducing firearm mortality. Funding None.

Can Statewide Emergency Department, Hospital Discharge, and Violent Death Reporting System Data Be Used to Monitor Burden of Firearm-Related Injury and Death in Rhode Island?

National data on the epidemiology of firearm injuries and circumstances of firearm deaths are difficult to obtain and often are nonreliable. Since firearm injury and death rates and causes can vary substantially between states, it is critical to consider state-specific data sources. In this study, we illustrate how states can systematically examine demographic characteristics, firearm information, type of wound, toxicology tests, precipitating circumstances, and costs to provide a comprehensive picture of firearm injuries and deaths using data sets from a single state with relatively low rates of firearm injury and death. Cross-sectional study. Firearm-related injury data for the period 2005-2014 were obtained from the Rhode Island emergency department and hospital discharge data sets; death data for the same period were obtained from the Rhode Island Violent Death Reporting System. Descriptive statistics were used. Healthcare Cost and Utilization Project cost-to-charge ratios were used to convert total hospital charges to costs. Most firearm-related emergency department visits (55.8%) and hospital discharges (79.2%) in Rhode Island were from assaults; however, most firearm-related deaths were suicides (60.1%). The annual cost of firearm-related hospitalizations was more than $830 000. Most decedents who died because of firearms tested positive for illicit substances. Nearly a quarter (23.5%) of firearm-related homicides were due to a conflict between the decedent and suspect. More than half (59%) of firearm suicide decedents were reported to have had current mental or physical problems prior to death. Understanding the state-specific magnitude and patterns (who, where, factors, etc) of firearm injury and death may help inform local injury prevention efforts. States with similar data sets may want to adopt our analyses. Surveillance of firearm-related injury and death is essential. Dissemination of surveillance findings to key stakeholders is critical in improving firearm injury prevention. States that are not part of the National Violent Death Reporting System (NVDRS) could work with their other data sources to obtain a better picture of violent injuries and deaths to make the best use of resources.