Long-term mortality of patients surviving firearm violence

Fahimi, Jahan; Larimer, Emily L.; Hamud-Ahmed, Walid; Anderson, Eric G.; Schnorr, Ch.; Yen, Irene H.; Alter, Harrison J.

doi:10.1136/injuryprev-2015-041710

Cited by 34 publications

(29 citation statements)

References 21 publications

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“…Our findings are consistent with those of two recent cohort studies that reported increased all‐cause and firearm‐related mortality among both firearm injury (AHR = 2.54 and 4.3, 95% CI = 1.41–4.59 and 1.3–14.1, respectively) and NFA survivors (AHR = 1.64, 95% CI = 1.01–2.68) compared to accidentally injured and noninjured patients, further expanding this understanding of long‐term risk to include the pediatric population. In the recent investigation by Fahimi et al., nonfatal firearm injury and NFA both carried a 5% risk of death at 5 years; our study further underscores that children and adolescents who are seen in urban trauma centers for either FA or NFA may both be at similarly high risk for mortality over time. However, while most deaths in the former study's surviving firearm injury cohort occurred in the first year after index injury, the median time to death among FA and NFA subjects in the present study was 4.6 and 5.3 years, respectively.…”

Section: Discussionsupporting

confidence: 91%

“…For example, in one prospective cohort of assault‐exposed youth aged 14 to 24 years, 59% experienced subsequent exposure to gun violence (either aggression or victimization) within 2 years of their initial ED visit . In contrast with their influence on short‐term mortality, clinical and injury‐specific covariates were not significant predictors of long‐term mortality in our sample and, therefore, medical complications of more severe injuries were unlikely to play an important role in conveying this increased risk. On the other hand, given that falling victim to firearm or NFA often reflects community‐level violence, we hypothesize that community‐level factors associated with firearm injury and homicide may play a more important role in long‐term mortality risk than the individual‐level factors examined in this study.…”

Section: Discussionmentioning

confidence: 69%

“…Pediatric and youth survivors of firearm injury and other forms of assault are at particularly high risk of trauma recidivism . Recent evidence suggests that both firearm injury and nonfirearm assault (NFA) patients presenting to an urban emergency department (ED) have higher risk of 5‐year mortality in comparison to those who present after motor vehicle collision, and those victimized by firearms have a particularly high risk of death in the first year after their index injury, largely due to homicide by firearm . Research on long‐term outcomes among pediatric FA survivors is sparse.…”

mentioning

confidence: 99%

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Long‐term Mortality in Pediatric Firearm Assault Survivors: A Multicenter, Retrospective, Comparative Cohort Study

Shaahinfar

Yen

Alter

et al. 2018

Academic Emergency Medicine

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Objectives: The objective was to determine whether children surviving to hospital discharge after firearm assault (FA) and nonfirearm assault (NFA) are at increased risk of mortality relative to survivors of unintentional trauma (UT). Secondarily, the objective was to elucidate the factors associated with long-term mortality after pediatric trauma.Methods: This was a multicenter, retrospective cohort study of pediatric patients aged 0 to 16 years who presented to the three trauma centers in San Francisco and Alameda counties, California, between January 2000 and December 2009 after 1) FA, 2) NFA, and 3) UT. The Social Security Death Master File and the California Department of Public Health Vital Statistics (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) were queried through December 31, 2014, to identify those who died after surviving their initial hospitalization and to delineate cause of death. Multivariate Cox proportional hazards regression was performed to determine associations between exposure to assault and long-term mortality.Results: We analyzed 413 FA, 405 NFA, and 7,062 UT patients who survived their index hospital visit. A total of 75 deaths occurred, including 3.9, 3.2, and 0.7% of each cohort, respectively. Two-thirds of all long-term deaths were due to homicide. After multivariate adjustment, adolescent age, male sex, black race/ethnicity, and public insurance were independent risk factors for long-term mortality. FA (adjusted hazard ratio [AHR] = 1.8, 95% confidence interval [CI] = 0.82-4.0) and NFA (AHR = 1.9, 95% CI = 0.93-3.9) did not convey a statistically significant difference in risk of long-term mortality compared to UT. Being assaulted by any means (with or without a firearm), however, was an independent risk factor for long-term mortality in the full study population (AHR = 1.9, 95% CI = 1.01-3.4) and among adolescents (AHR = 1.9, 95% CI = 1.01-3.6).Conclusion: Children and adolescents who survive assault, including by firearm, have increased long-term mortality compared to those who survive unintentional, nonviolent trauma.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 69%

mentioning

confidence: 99%

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Long‐term Mortality in Pediatric Firearm Assault Survivors: A Multicenter, Retrospective, Comparative Cohort Study

Shaahinfar

Yen

Alter

et al. 2018

Academic Emergency Medicine

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“…Conversely, studies have shown elevated mortality risk after recovery from firearm injury, which may have lowered our measured recurrence rate. 4,5 …”

Section: Discussionmentioning

confidence: 99%

“…2 Recurrent injury is a promising target for prevention, as prior injury is a predictor of future violent injury 3 and death. 4–6 Hospital-based violence intervention programs show promising results with in reducing re-injury and costs by using an initial injury visit to initiate prevention, 7,8 but appropriately scaling and distributing violence prevention resources requires a more accurate understanding of the incidence, risk factors, and impact of recurrent violent injury.…”

Section: Introductionmentioning

confidence: 99%

Recurrent violent injury: magnitude, risk factors, and opportunities for intervention from a statewide analysis

Kaufman

Rising

Wiebe

et al. 2016

The American Journal of Emergency Medicine

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Introduction Though preventing recurrent violent injury is an important component of a public health approach to interpersonal violence, and a common focus of violence intervention programs, the true incidence of recurrent violent injury is unknown. Prior studies have reported recurrence rates from 0.8% to 44%, and risk factors for recurrence are not well established. Methods We used a statewide, all-payer database to perform a retrospective cohort study of emergency department visits for injury due to interpersonal violence in Florida, following patients injured in 2010 for recurrence through 2012. We assessed risk factors for recurrence with multivariable logistic regression and estimated time to recurrence with the Kaplan-Meier method. We tabulated hospital charges and costs for index and recurrent visits. Results Of 53,908 patients presenting for violent injury in 2010, 11.1% had a recurrent violent injury during the study period. Trauma centers treated 31.8%, including 55.9% of severe injuries. Among recurrers, 58.9% went to a different hospital for their second injury. Low income, homelessness, Medicaid or uninsurance, and Black race were associated with increased odds of recurrence. Patients with visits for mental and behavioral health and unintentional injury also had increased odds of recurrence. Index injuries accounted for $105 million in costs, and recurrent injuries accounted for another $25.3 million. Conclusions Recurrent violent injury is a common and costly phenomenon, and effective violence prevention programs are needed. Prevention must include the non-trauma centers where many patients seek care.

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Gun Violence Exposure and Experiences of Depression Among Mothers

2021

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Gun violence is a uniquely prevalent issue in the USA that disproportionately affects disadvantaged families already at risk of health disparities. Despite the traumatic nature of witnessing gun violence, we have little knowledge of whether exposure to local gun violence is associated with higher risks of depression among mothers, whose symptoms of depression are likely to have spillover effects for kin. We examined the association between exposure to gun violence in mothers' neighborhoods and their experiences of depression using longitudinal Fragile Families and Child Wellbeing Study data (n = 4587) in tandem with lagged outcome and fixed effect models. We find that mothers who witness at least one shooting in their neighborhoods or local communities exhibit more symptoms of depression and are 32-60% more likely to meet criteria for depression than mothers who do not witness a shooting. We also find that witnessing a shooting is associated with increases in parental aggravation, which is partially mediated by maternal depression. Given this and other previously documented spillover effects of mothers' mental health on children and family members, these findings have important implications for mothers' wellbeing and their kin. Further, we observe substantial racial and socioeconomic disparities in exposure to gun violence, suggesting that gun violence may heighten health disparities and drawing attention to the importance of providing mental health resources in communities that are most affected by gun violence.

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Long-term mortality of patients surviving firearm violence

Abstract: Among individuals presenting to the ED after injury or assault and surviving to discharge, firearm injury exposure is an important predictor of death within 5 years and most pronounced in the first year after injury.

Cited by 34 publications

References 21 publications

Long‐term Mortality in Pediatric Firearm Assault Survivors: A Multicenter, Retrospective, Comparative Cohort Study

Long‐term Mortality in Pediatric Firearm Assault Survivors: A Multicenter, Retrospective, Comparative Cohort Study

Recurrent violent injury: magnitude, risk factors, and opportunities for intervention from a statewide analysis

Gun Violence Exposure and Experiences of Depression Among Mothers

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