Close is dead: determinants of firearm injury lethality in women

Accurate data regarding intimate partner violence is difficult to obtain, particularly when examining only homicides or trauma registries. This study characterizes firearm violence against women by examining data from both the county coroner and an urban level I trauma center.

The Trauma Registry and Coroners database were reviewed for female victims of firearm assault from 1998 to 2006. Data collected included age, race, location of assault (home, public, unknown), mortality, and injuries. Assailants were categorized as intimate partners (IP), acquaintances, strangers, or undetermined. Adjusted odds ratios for effects of assailant and location were calculated using logistic regression analysis, with statistical significance at alpha = 0.05.

Of 115 victims identified, 51 (44%) were fatally injured. Forty-two (37%) of assailants were IP. Fatalities occurred in 71% of IP, 50% of acquaintance, and 20% of stranger assaults. Firearm assault by IP was 10 times more lethal than injury by stranger (p < 0.0005). Assaults at home occurred 54% of the time and had 60% mortality. Assault at home was 3.8 times more lethal than assault in public (p < 0.002). Seventy-nine percent of IP assaults, 63% of acquaintance assaults, and 29% of stranger assaults occurred in the home. In 99 victims with documented injuries, head injuries were found in 68% of IP assaults, compared with 33% and 16% of acquaintance and stranger assaults.

IP firearm assaults against women may be underrepresented in current databases. These assaults are highly lethal, frequently occur at home, and often involve head injury. These observations may lend to strategies for trauma prevention.