Nonfatal Firearm Injury and Subsequent Emergency Department Utilization Among Nonelderly Adults

The mortality, long-term morbidity, and exacerbated healthcare needs due to firearm injury in the U.S. are significant and growing. However, the relationship between exposure to a nonfatal firearm injury and long-term emergency department (ED) utilization is poorly understood. This study estimates the association between exposure to a nonfatal firearm injury and ED utilization in the subsequent year.

Using all-payer ED data among nonelderly adults in Georgia and New York, all ED visits for nonfatal firearm injuries from 2017 to 2018 were identified. Sociodemographic, clinical, and contextual characteristics between nonfatal firearm injury ED patients and the broader population of ED users were compared. ED utilization in the year following a nonfatal firearm injury relative to ED use in the year before and compared with ED use by a propensity score matched control group was examined using Poisson and negative binomial multivariable regressions. Analyses were performed in 2024.

Nonfatal firearm injury ED patients were disproportionately male, younger, non-Hispanic Black, uninsured, and residents of areas with low median income and high firearm ownership. Compared to a matched control group, multivariable analyses indicated that nonfatal firearm injury ED patients had significantly higher risks of having hospital admissions through the ED (aRR: 1.42), all-cause injury-related ED visits (aRR: 1.47), nonfirearm injury-related ED visits (aRR: 1.26), and additional nonfatal firearm injury-related ED visits (aRR: 325.45) in the subsequent year (p<0.001 for all). About one in every eight ED users with a firearm-related injury at index also sought ED care for another nonfatal firearm injury within 1 year.

Nonfatal firearm-related injuries contribute to preventable harm, health inequity, and increased ED utilization.