C. K. Cantrell1, R. Griffin1, T. Swain1, K. Hendershot1 1University Of Alabama at Birmingham,Birmingham, Alabama, USA
Introduction: Firearm injury is one of the leading causes of death in individuals in the United States. Many factors play into mortality from firearm injuries. Two factors in mortality are time from injury to treatment and the quality of the treatment received. One recommendation that the ACS COT introduced in attempt to decrease firearm injury fatalities, as well as fatalities from other mechanisms of injury, was for each state to unify their trauma centers and create a statewide trauma system. Illinois, in 1971, was the first state to undergo this transition. Most of these transitions have been more recent, with the percent of states with a trauma system nearly doubling in the past 15 years while the rate of firearm incidents continues to rise.
Methods: For this cross-sectional study, data on firearm-related intentional deaths (i.e., suicides and homicides excluding legal intervention) were collected by state for years 2000-2014 from the CDC’s Web-based Injury Statistics Query and Reporting System (WISQARS). For each state, the presence of a state trauma system was determined by year as derived from state Public Health Department information. A General Estimating Equations negative binomial regression was used to estimate rate ratios (RRs) for the association between presence of a state trauma system and intentional mortality rate using the state’s population as an offset.
Results: The proportion of states with a state trauma system nearly doubled from 40% (n=20) in 2000 to 78% (n=39) in 2014 (see Graph 1). Overall, there was no association between presence of a state trauma system and intentional firearm-related mortality rate (RR 0.94, 95% CI 0.81-1.09). The lack of association remained for both firearm homicides (RR 0.83, 95% CI 0.63-1.07) and suicides (RR 0.98, 95% CI 0.82-1.16). The lack of association was observed across 5-year categories, though there was noted difference in the associations by year for firearm homicide, with 23% decrease in the rate observed among states with a trauma system in 2005-2009 (RR 0.77, 95% CI 0.58-1.03) while a near-null effect was observed for 2010-2014 (RR 0.91, 95% CI 0.62-1.32). Near-null associations were observed across the board for firearm suicide rate.
Conclusion: The lack of effect of trauma system presence on firearm suicide rate is not unexpected given the high case fatality rate of these injuries. Though presence of a state trauma system is not associated with the mortality rate, it would be of interest to determine whether the case fatality rate of intentional injury varies by presence of a trauma system.
