M. Loe1, J. DeMond1, M. Ghio1, J. Fleckman2,3, J. Constans2, D. Tatum1, P. McGrew1, J. Duchesne1, F. Gray4, K. P. Theall2,3, S. Taghavi1,2 1Tulane University School Of Medicine, Surgery, New Orleans, LA, USA 2Tulane University Violence Prevention Institute, New Orleans, LA, USA 3Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA 4Louisiana State University Health Sciences Center, Surgery, New Orleans, LA, USA
Introduction: Centers for Medicare and Medicaid Services will require hospitals to collect measures of housing instability in 2024. Stable housing is a vital social determinant of health. How housing influences gun violence in a major city in the United States (US) has not been examined. We hypothesized that housing instability (HI) in a major US city would be associated with firearm injuries (FI).
Methods: FI was collected from a single institution that serves as the only Level I trauma [TDM1] center in a major southern US city, with its catchment area spanning 9 county-equivalents, from 2017–2022. Point-in-time counts of homelessness and housing unit density was obtained from US Housing and Urban Development (HUD). Foreclosure rate, percentage of vacancy, mobile homes[TDM2] , renter tenants, and long-term occupants were obtained from the American Community Survey. Number of federally assisted housing (FAH) subsidies and percentage of FAH units (%FH) were obtained from the National Housing Preservation Database, and minimum/mean renter wage hours needed to afford basic housing as reported by the National Low Income Housing Coalition were also examined. Linear regression analysis was used to examine the relationship between HI proxies at the county-equivalent level and rates of overall FI and firearm deaths (FD) on univariate analysis.
Results: There was a total of 4173 FI across 9 county-equivalents, with 527 (12.6%) FDs. The FI cohort was 85.9% male, 91.0% nonwhite, and of average age 29.8 years. On univariate analysis, homelessness count (b=0.12, p=0.003), unit density (b=0.02, p=0.01), percent vacancy (b=2.34, p=0.04), FAH subsidies (b=1.84, p=0.004) and %FH (b=3.36, p=0.01) were significantly associated with higher FI. [MG3] Variables not associated with FI included foreclosure rate (b=0.50, p=0.56), work hours at minimum (b=0.26, p=0.32) and mean-renter wage (b=0.68, p=0.23) needed to afford housing, and percentage of renters (b=72.35, p=0.06), long-term tenants (b=-0.56, p=0.34), or mobile homes[TS4] (b=-0.83, p=0.06). On multivariate analysis (Table), FAH subsidies and % vacancy were associated with incidence of FI. Each additional FAH subsidy per 100,000 correlated with 1.55 additional FI. Every 1% increase in vacancies was related to approximately 2.12 additional FI. Unit density was not associated with FI (b=0.019, p=0.18). On multivariate analysis, neither FAH subsidies (b=0.01, p=0.25), % vacancy (b=0.009, p=0.17), nor unit density (b=0.0001, p=0.22) were associated with FD.
Conclusion: Measures of housing instability are associated with increased rates of FI but not FD. Public health interventions targeting stable housing may help reduce gun violence and associated outcomes.
