Fatal Pediatric Firearm Injuries: When and Where Are Children at Risk?

In 2022, firearms injured or killed more than 6000 American children. Significant disparities exist in injury risk. We hypothesized that analyzing an injury's time, date, and location could help identify additional risk and protective factors in the pediatric population.

We performed a retrospective analysis of the 2003-2020 National Violent Death Reporting System. The National Violent Death Reporting System currently collects data from all 50 states, the District of Columbia, and Puerto Rico. Demographic (age, sex, race/ethnicity) and incident (date, time, location) data were abstracted. Inclusion criteria were pediatric victims (age≤18) of fatal firearm injuries. Records with missing values were excluded. Chi-squared tests were used to test the association between victim demographics and time, date, or location. Significance was P < 0.05.

Nine thousand fifty-eight children (male: 83.5% [n = 7559]), age: 17 yrs old (interquartile range: 15-18 years old), Black: 64.1% [n = 5810]) were eligible. 6161 (68.1%) of children had not completed high school. 3308 (36.5%) fatal injuries occurred after school or at night (1601-2359 h). 3678 (40.6%) injuries occurred at home. Black children were significantly more likely to be injured during the summer months (June - August, P < 0.01), after school or at night (P < 0.001), and along a street (P < 0.001). Hispanic children were more likely to be killed after school or at night (P < 0.001) and along a street (P < 0.001). There was no seasonal variation in this demographic. Compared to other times of the day, there was a significant increase in weekend (Friday-Sunday) morning (0000- 0800) injuries. (P < 0.001).

Firearm violence disproportionately impacts Black children. There are significant associations with the time and season. Interventions during those times such as extended academic engagement or after school programs beyond the traditional school day and school year may afford opportunities which could mitigate exposure to firearm violence.