Nonfatal Firearm Injuries by Intent in the United States: 2016-2018 Hospital Discharge Records from the Healthcare Cost and Utilization Project

Abstract

Introduction In addition to the nearly 40,000 firearm deaths each year, nonfatal firearm injuries represent a significant public health burden to communities in the United States. We aimed to describe the incidence and rates of nonfatal firearm injuries. Methods We calculated nonfatal firearm injury estimates using the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality, including the Nationwide Emergency Department Samples and the National Inpatient Samples. We used the International Classification of Diseases, 10th Revision, Clinical Modification to identify firearm injury episodes. Deaths in the emergency department (ED) or as inpatients were excluded. Results In addition to the 118,171 persons shot and killed by firearms from 2016–2018, 228,380 people were shot (ratio 1.9:1) and treated at a hospital ED or admitted to hospital, a rate of 23.4 nonfatal firearm injury episodes per 100,000 population. The number of nonfatal injury episodes varied by year: 2018 had the lowest at 69,692, compared to 84,776 in 2017 and 73,912 in 2016. Unintentional injury episodes were the most frequent, accounting for 58.5% (n = 81,217) and 38.9% (n = 34,820) of total nonfatal firearm hospital discharges from the ED and inpatients, respectively. Assault episodes were the next most frequent, at 36.3% (n = 50,482) of ED and 49.5% (n = 44,290) of inpatient discharges. The highest rate of nonfatal firearm injury by five-year age group was for 20- to 24-year-olds. With an annual rate of 73.53 per 100,000 population, the rates for ages 20–24 were more than 10 times higher than the rates for patients younger than 15 or 60 years and older. More than half (53.4%, n = 121,884) of hospital-treated, nonfatal firearm injury episodes were patients living in ZIP codes with a median household income in the lowest quartile, compared to 7.5% (n = 17,102) for patients residing in the highest income quartile ZIP codes, a sevenfold difference. Conclusion For every person shot and killed by a gun in the US, two more are wounded. Unlike firearm deaths, which are predominantly suicides, most nonfatal firearm injury episodes are unintentional or with an assault intent. Having a reliable source of nonfatal injury data is essential to understanding the incidence of firearm injuries.

Injury Characteristics, Outcomes, and Health Care Services Use Associated With Nonfatal Injuries Sustained in Mass Shootings in the US, 2012-2019

“…Our mostly non-Hispanic White proportion of injured patients (69.9%) from CPMSs contrasts with the largely Black and Hispanic or Latino (64%) patients among all nonfatal firearm injuries . The proportion of publicly insured or uninsured patients in our study (64.3%) was the same as that for all firearm injuries .…”

“…We could not obtain data from the Pulse Nightclub shooting in Orlando, Florida, but Smith et al 24 25 Our mostly non-Hispanic White proportion of injured patients (69.9%) from CPMSs contrasts with the largely Black and Hispanic or Latino (64%) patients among all nonfatal firearm injuries. 26 The proportion of publicly insured or uninsured patients in our study (64.3%) was the same as that for all firearm injuries. 27 Our distribution of CPMS ESI triage categories reflects substantially higher acuity than a US population treated in the ED for nondisaster incidents.…”

Assessment of the Accuracy of Firearm Injury Intent Coding at 3 US Hospitals

“…The findings of this cross-sectional study underscore questions raised by prior work about the accuracy of discharge data as a source of firearm injury intent, and by extension, the validity of findings from studies that have used ICD -coded discharge data to describe aspects of intent-specific firearm injuries, such as how many have occurred, the demographic distribution of the people injured, and the medical costs they engender …”

“…The findings of this cross-sectional study underscore questions raised by prior work about the accuracy of discharge data as a source of firearm injury intent, and by extension, the validity of findings from studies that have used ICD-coded discharge data to describe aspects of intent-specific firearm injuries, such as how many have occurred, the demographic distribution of the people injured, and the medical costs they engender. [15][16][17][18][19][20][21][22][23][24][25] Author Contributions: Drs Miller and Rowhani-Rahbar had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.…”

The Science of Gun Policy: A Critical Synthesis of Research Evidence on the Effects of Gun Policies in the United States, Third Edition

“…1 More than 39,000 Americans die annually from deliberate and unintentional gun injuries, and two-thirds of these deaths are suicides . Another 50,000 to 150,000 Americans per year receive care in a hospital for a nonfatal gun injury (Schnippel et al, 2021;Kaufman et al, 2021;Avraham, Frangos, and DiMaggio, 2018). 2 Multiple recent high-profile mass public shootings have focused national attention on the need to reduce the scale and scope of gun violence in the United States (Niforatos, Zheutlin, and Pescatore, 2019;Biden, 2022).…”