Race and ethnicity, neighborhood poverty and pediatric firearm hospitalizations in the United States

Kalesan, Bindu; Vyliparambil, Mrithyunjay A; Bogue, Erin; Villarreal, Marcos D.; Vasan, Sowmya; Fagan, Jeffrey; DiMaggio, Charles; Stylianos, Steven; Galea, Sandro

doi:10.1016/j.annepidem.2015.10.009

Cited by 57 publications

(41 citation statements)

References 22 publications

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“…This injury mechanism is becoming increasingly common, up 4% overall and nearly 30% among children under the age of 5. Suicide attempts, which on average are associated with a high mortality, may be contributing to the increase in firearm‐related injuries in the 18‐ to 44‐year age group; however, this does not account for the increases in the very young. Firearm‐related injury trends in young children disproportionately affect African American and other minority communities, irrespective of socioeconomic standing .…”

Section: Discussionmentioning

confidence: 99%

“…We included age as a continuous variable in our model of hospital type and mortality. While age is generally accepted and “well‐known risk factor” for trauma mortality, and there is a general clinical recognition that the consequences of traumatic injury are increased in the elderly compared to the very young, there is some room for debate on how or if the relationship is linear. Age has been shown to behave as an effect modifier in some settings and to demonstrate a threshold effect in other settings .…”

Section: Limitationsmentioning

confidence: 99%

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The Epidemiology of Emergency Department Trauma Discharges in the United States

DiMaggio

Avraham

Lee

et al. 2017

Academic Emergency Medicine

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Objective Injury related morbidity and mortality is an important emergency medicine and public health challenge in the United States (US). Here we describe the epidemiology of traumatic injury presenting to US emergency departments, define changes in types and causes of injury among the elderly and the young, characterize the role of trauma centers and teaching hospitals in providing emergency trauma care, and estimate the overall economic burden of treating such injuries. Methods We conducted a secondary retrospective, repeated cross-sectional study of the Nationwide Emergency Department Data Sample (NEDS), the largest all-payer emergency department survey database in the US. Main outcomes and measures were survey-adjusted counts, proportions, means, and rates with associated standard errors, and 95% confidence intervals. We plotted annual age-stratified emergency department discharge rates for traumatic injury and present tables of proportions of common injuries and external causes. We modeled the association of Level 1 or 2 trauma center care with injury fatality using a multi-variable survey-adjusted logistic regression analysis that controlled for age, gender, injury severity, comorbid diagnoses, and teaching hospital status. Results There were 181,194,431 (standard error, se = 4234) traumatic injury discharges from US emergency departments between 2006 and 2012. There was an average year-to-year decrease of 143 (95% CI -184.3, -68.5) visits per 100,000 US population during the study period. The all-age, all-cause case-fatality rate for traumatic injuries across US emergency departments during the study period was 0.17% (se = 0.001). The case-fatality rate for the most severely injured averaged 4.8% (se = 0.001), and severely injured patients were nearly four times as likely to be seen in Level 1 or 2 trauma centers (relative risk = 3.9 (95% CI 3.7, 4.1)). The unadjusted risk ratio, based on group counts, for the association of Level 1 or 2 trauma centers with mortality was RR = 4.9 (95% CI 4.5, 5.3), however, after accounting for gender, age, injury severity and comorbidities, Level 1 or 2 trauma centers were not associated with an increased risk of fatality (odds ratio = 0.96 (0.79, 1.18)). There were notable changes at the extremes of age in types and causes of emergency department discharges for traumatic injury between 2009 and 2012. Age-stratified rates of diagnoses of traumatic brain injury increased 29.5% (se = 2.6) for adults older than 85, and increased 44.9% (se = 1.3) for children younger than 18. Firearm related injuries increased 31.7% (se = 0.2) in children five years and younger. The total inflation-adjusted cost of emergency department injury care in the US between 2006 and 2012 was $99.75 billion (se = 0.03). Conclusions Emergency departments are a sensitive barometer of the continuing impact of traumatic injury as an important cause of morbidity and mortality in the US. Level 1 or 2 trauma centers remain a bulwark against the tide of severe trauma in the US. But, the types and caus...

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

The Epidemiology of Emergency Department Trauma Discharges in the United States

DiMaggio

Avraham

Lee

et al. 2017

Academic Emergency Medicine

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“…Overall, our results indicate that, across the US, there are over 190 daily ED discharges for firearm-related injuries. A number of studies suggest that these injuries disproportionately occurs in African-American and other minority communities, irrespective of socioeconomic standing (Kalesan et al, 2016 ; Kalesan et al, 2014 ; Srinivasan et al, 2014 ). We report that nearly half of all such injuries impact those who reside in predominantly poor neighborhoods.…”

Section: Discussionmentioning

confidence: 99%

The epidemiology of firearm injuries managed in US emergency departments

2018

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BackgroundFirearm-related injuries cause significant morbidity and mortality in the United States (US), consuming resources and fueling political and public health discourse. Most analyses of firearm injuries are based on fatality statistics. Here, we describe the epidemiology of firearm injuries presenting to US emergency departments (EDs).MethodsWe performed a retrospective study of the Healthcare Cost and Utilization Program Nationwide Emergency Department Survey (NEDS) from 2009 to 2012. NEDS is the largest all-payer ED survey in the US containing approximately 30 million annual records. Results include survey-adjusted counts, proportions, means, and rates, and confidence intervals of age-stratified ED discharges for firearm injuries.ResultsThere were 71,111 (se = 613) ED discharges for firearm injuries in 2009; the absolute number increased 3.9% (se = 1.2) to 75,559 (se = 610) in 2012. 18-to-44-year-olds accounted for the largest proportion of total injuries with 52,187 (se = 527) in 2009 and 56,644 (se = 528) in 2012—a 7.2% (se = 1.6) relative rate increase and an absolute increase of 3.3/100,000 (se = 0.7). Firearm injuries among children < 5-years-old increase 16%, and 19% among children 5-to-9-years-old. 136,112 (se = 761)—or 48.2%—of those injured were treated and discharged home without admission; 106,927 (se = 755) were admitted. Firearm deaths represented one-third of all trauma mortality. Three-quarters of those injured resided in neighborhoods with median incomes below $49,250.ConclusionsFirearm injuries increased from 2009 to 2012, driven by adults aged 18-to-44-years-old, and disproportionately impacting lower socioeconomic communities. Injuries also increased among young children. Firearm injuries remain a continued public health challenge, and a significant source of ED morbidity and mortality.

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“…Similarly, Black children were hospitalized after firearm injuries more frequently than other children, regardless of economic status. 34 We have provided further insights into this complex issue by examining the impact of state firearm legislation on race. Our findings suggest that legislation put into effect to protect Americans against firearm injury may not do so equally.…”

Section: Discussionmentioning

confidence: 99%

Firearm Deaths in America

et al. 2017

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Objective We sought to determine whether state firearm legislation correlated with firearm-related fatality rates (FFR) during a 15-year period. Background The politicized and controversial topic of firearm legislation has been grossly understudied when the relative impact of American firearm violence is considered. Scientific evidence regarding gun legislation effectiveness remains scant. Methods Demographic and intent data (1999–2013) were collected from the Centers for Disease Control and Prevention’s Web-Based Injury Statistics Query and Reporting System database and compared by state firearm legislation rankings with respect to FFR. State scorecards were obtained from firearm-restrictive (Brady Campaign/Law Center against Gun Violence [BC/LC]) and less-restrictive (National Rifle Association) groups. FFR were compared between restrictive and least-restrictive states during 3 periods (1999–2003, 2004–2008, 2009–2013). Results During 1999 to 2013, 462,043 Americans were killed by firearms. Overall FFR did not change during the 3 periods (10.89±3.99/100,000; 10.71±3.93/100,000; 11.14±3.91/100,000; P=0.87). Within each period, least-restrictive states had greater unintentional, pediatric, and adult suicide, White and overall FFR than restrictive states (all P<0.05). Conversely, no correlation was seen, during any of the 3 time periods, with either homicide or Black FFR—population subsets accounting for 41.7% of firearm deaths. Conclusions Restrictive firearm legislation is associated with decreased pediatric, unintentional, suicide, and overall FFR, but homicide and Black FFR appear unaffected. Future funding and research should be directed at both identifying the most effective aspects of firearm legislation and creating legislation that equally protects every segment of the American population.

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Race and ethnicity, neighborhood poverty and pediatric firearm hospitalizations in the United States

Cited by 57 publications

References 22 publications

The Epidemiology of Emergency Department Trauma Discharges in the United States

The Epidemiology of Emergency Department Trauma Discharges in the United States

The epidemiology of firearm injuries managed in US emergency departments

Firearm Deaths in America

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