Association of Gun Violence With Emergency Department Visits for Stress-Responsive Complaints

We evaluate the association between living near a neighborhood shooting and emergency department (ED) utilization for stress-responsive complaints.

In this location-based before-and-after neighborhood study, we examined variability in ED encounter volume for stress-responsive complaints after neighborhood shooting incidents around 2 academic hospitals. We included patients residing within 1/8- and 1/2-mile-diameter buffers around a shooting (place) if their ED encounter occurred 7, 30, or 60 days before or after the shooting (time). Prespecified outcomes were stress-responsive complaints (chest pain, lightheadedness, syncope, hypertension, shortness of breath, asthma, anxiety, depression, and substance use) based on prior literature for stress-responsive diseases. Conditional logistic regression was used to calculate the odds of presentation to the ED with a stress-responsive complaint after, compared with before, a neighborhood shooting incident.

Between January 2013 and December 2014, 513 shooting incidents and 19,906 encounters for stress-responsive complaints were included in the analysis. Mean age was 50.3 years (SD 22.3 years), 61.5% were women, and 91% were black. We found increased odds of presenting with syncope in 2 place-time buffers: 30 days in the 1/8-mile buffer (odds ratio 2.61; 99% confidence interval 1.2 to 5.67) and 60 days in 1/8-mile buffer (odds ratio 1.56; 99% confidence interval 0.99 to 2.46). No other chief complaints met our statistical threshold for significance.

This study evaluated the relationship between objectively measured gun violence exposure and short-term health effect at a microspatial scale. Overall, this was a study with largely negative results, and we did not find any consistent dose-response pattern in time or space regarding neighborhood shootings and stress-responsive presentations to the ED. Theoretic links make this relationship plausible, however, and further investigation is needed to understand the short-term health consequences of violence exposure, and whether those vary based on the circumstances that are experienced inherently by residents of a given neighborhood.