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Trends in pediatric firearm-related injuries and disparities in acute outcomes
Makda G Mulugeta1, Gabrielle Bailey1, Kendall Parsons1
1Children's Healthcare of Atlanta, Atlanta, GA, United States.
Insights
Firearm-related injuries in children are rising, particularly among Black youth. New state firearm laws and the COVID-19 pandemic correlate with increased injury rates, highlighting the need for further research into disparities.
Area of Science:
- Public Health
- Epidemiology
- Trauma Surgery
Background:
- Firearm-related injuries (FRI) represent a growing public health crisis in children, with socioeconomic factors contributing to the rise.
- Research on disparities and social determinants of health in pediatric FRI remains limited despite increasing incidence, especially post-COVID-19.
- Understanding trends and influences on pediatric FRI is crucial for developing targeted prevention strategies.
Purpose of the Study:
- To investigate the epidemiology of pediatric firearm-related injuries in Atlanta.
- To analyze trends in pediatric FRI over time, including the impact of COVID-19 and a specific state firearm law (SB 319).
- To examine disparities in clinical outcomes, such as mortality, based on race and insurance status.
Main Methods:
- A retrospective cohort study of 701 pediatric patients (0-20 years) with FRI from January 2014 to April 2023.
- Utilized interrupted time series (ITS) models to assess the impact of COVID-19 and SB 319 on FRI rates.
- Compared clinical outcomes (mortality, admission, discharge) between racial and insurance groups using inverse propensity treatment weights (IPTW) for adjustment.
Main Results:
- The majority of pediatric FRI patients were male (76.7%), Black (74.9%), publicly insured (82.6%), and injured by unintentional shootings or assault.
- Significant increases in FRI rates were observed during the COVID-19 pandemic and after the implementation of SB 319 (permit-less concealed firearm carry).
- Publicly insured patients initially showed lower mortality odds, but this association was not significant after controlling for confounders.
Conclusions:
- Pediatric firearm-related injuries are increasing, disproportionately affecting Black children.
- Mortality disparities based on insurance status require further investigation.
- Ongoing monitoring of FRI trends is essential for informing effective preventative measures, especially considering the lingering effects of COVID-19 and the continued presence of SB 319.
Background:
Firearm-related injuries (FRI) are an increasing cause of death and injury in children. The etiology for this rise is multifactorial and includes socioeconomic factors. Despite its prevalence and documented increase over COVID-19, there is a paucity of research on disparities and the influence of social determinants of health (SDH) in pediatric FRI. This study aims to explore the epidemiology of this vulnerable population in Atlanta, trends over time and relevant dates such as COVID-19 and a state firearm law, and disparities in clinical outcomes.
Methods:
Retrospective cohort of patients with FRI (0-20 years-old, x̄=9.8, Median = 11) presenting to our hospital EDs from January 2014 to April 2023 (N = 701) and eligible for the Trauma Registry. This period includes two major events, namely the COVID-19 pandemic (March 2020), and passage of state law Constitutional Carry Act (SB 319) (April 2022), allowing for permit-less concealed firearm carry. Single series interrupted time series (ITS) models were run and clinical outcome differences between race and insurance groups were calculated unadjusted and adjusted for confounders using inverse propensity treatment weights (IPTW). The primary outcome was mortality; secondary are admission and discharge.
Results:
Majority of FRI involved patients who were male (76.7%), Black (74.9%), publicly insured (82.6%), ≤12 years-old (61.8%), and injured by unintentional shootings (45.6%) or assault (43.7%). During COVID-19, there was a sustained increase in FRI rate by 0.42 patients per 1,000 trauma visits per month (95% CI 0.02-0.82, p = 0.042); post-SB 319 it was 2.3 patients per 1,000 trauma visits per month (95% CI 0.23-4.31, p = 0.029). Publicly insured patients had 58% lower odds of mortality than privately insured patients (OR 0.42, 95% CI 0.18-0.99, p = 0.047). When controlled for race and mechanism of injury, among other confounding factors, this association was not significant (p = 0.652).
Conclusion:
Pediatric FRI are increasing over time, with disproportionate burdens on Black patients, at our hospitals. Disparities in mortality based on insurance necessitate further study. As social and economic repercussions of COVID-19 are still present, and state firearm law SB 319 is still in effect, assessment of ongoing trends is warranted to inform preventative strategies.
