M. Nuno1, M. K. Srour1, A. V. Lewis1, R. F. Alban1 1Cedars-Sinai Medical Center,Trauma And Critical Care Surgery,Los Angeles, CA, USA
Introduction:
Firearm violence in the USA results in the injury and death of thousands of individuals annually. In an effort to curtail this public health concern, firearm prevention strategies such as the Brady handgun violence prevention act – the Brady law have been proposed. Given the gaps inherent is some of these laws, these prevention strategies have resulted in limited success. The objective of this study was to evaluate the role of state-level gun laws, age and race on firearm related injuries and mortality among children and young adults admitted to US hospitals.
Methods:
A total of 27,566 children and young adults were identified using the Kids’ Inpatient Sample (KID) database (2000, 2003, 2006, and 2009). Data was obtained from the Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality (AHRQ) and all statistical analyses were conducted in SAS 9.2. Trends of injuries were explored in terms of state-level gun laws, age, and race. Admitting hospitals were stratified into 5 categories (A, B, C, D and F, with A representing states with the most strict and F states with the least strict laws) based on the Brady Campaign to prevent Gun Violence that assigns scorecards for every state. Descriptive statistics were provided and multivariate logistic regression was applied to evaluate factors associated with in-hospital mortality.
Results:
A total of 27,566 children and young adults were analyzed in this study. Most patients were young adults of age 15-19 years (87.3%), male (89.7%), black (53.7%), and admitted as emergent/urgent cases (85.0%). Most patients were discharged from teaching (81.9%) hospitals with large bedsize (70.9%), and located in southern states (34.2%). States with weaker gun laws had an increased rate in accidents while more assaults were documented in states with stronger gun laws. Accidents were significantly more common in children age 0-4 while assaults were prevalent in younger adults. Whites experienced more firearm related accidents while Black and Hispanics were victims of more assaults. Overall mortality was 6.4%; after adjusting for multiple factors we found that race (p=0.009), age (p<0.0001), and the type of firearm related injury (p=0.0011) were associated with mortality. Hispanics compared to Whites (OR 1.36, 95% CI: 1.03-1.78), children age 5-9 (OR 2.03, 95% CI: 1.30-3.17) compared to young adults (15-19), and suicides (OR 15.6, 95% CI: 11.6-20.9) in comparison to accidents had an increased risk of in-hospital mortality.
Conclusion:
Firearm related injury type was strongly correlated with state-level gun laws, age and race of victim. Accidents were most prevalent in states with weak gun laws, young children and Whites while assaults prevailed in states with stricter gun laws, young adults, and Black and Hispanics. Further disparities in mortality were found by race, age, and type of injury.