Trends and Disparities in Non-fatal Firearm Injuries among Working-Age Adults in the United States, 2000-2021

Firearm-related injuries remain a significant public health issue in the United States, with patterns and trends among various age groups not well characterized. This study analyzed time series trends and disparities in firearm injury rates among U.S. working-age adults from 2000 to 2021. A retrospective analysis using data from the National Electronic Injury Surveillance System-Firearm Injury Surveillance Study (NEISS-FISS) was conducted with a focus on non-fatal firearm injuries reported in emergency departments across a nationally representative sample of hospitals. Descriptive statistics were used to explore disparities across different demographic groups. Trends were assessed using locally estimated scatterplot smoothing (LOESS) and Joinpoint regression analysis. Between 2000 and 2021, an estimated 2.36 million non-fatal firearm injuries occurred, with males accounting for 85.7% and non-Hispanic Blacks (NHB) representing 48.8% of injuries. Firearm injuries were commonly associated with crime (29.8%), physical fights (24.7%), alcohol/substance use (17.7%), and verbal arguments (17.2%). Most incidents occurred on weekdays (63.7%) and assaults were the most prevalent intent (68.5%), followed by unintentional injuries (21.9%). Handguns (25.1%) and unspecified firearm types (61.2%) were the most commonly involved weapons. From 2000 to 2021, significant increases in firearm injuries were observed among those aged 26-45 years (23.0%), women (21.97%), NHB (42.15%), and those involving assaults (231.9%). Age-specific trends showed a significant annual percentage change (APC) increase of 4.9% for 18-25 years, 12.4% for 26-45 years, and 7.0% for 46-64 years from 2013 to 2021. Racial/ethnic trends revealed a significant APC increase of 5.0% for Non-Hispanic Whites (2014-2021), 25.0% for NHB (2015-2021), and a decrease of -31.3% followed by an increase of 15.6% for Hispanics (2012-2021). The disproportionate burden of firearm injuries among different age and racial/ethnic groups highlights the need for targeted prevention strategies and ongoing monitoring of injuries.