Geographic and Demographic Disparity in Firearm Injury: 33-Year Retrospective Cohort Analysis of Florida Communities

Firearm violence in America has been declared a public health crisis. This study investigates variation in firearm injuries by county-level characteristics and intent of firearm use.

The open-access FLHealthCHARTS was searched for firearm injuries from 1989 to 2022. Intentional firearm injury rates and unintentional firearm injury rates were collected as the number of injuries per 100,000 citizens, categorized by race and ethnicity. They were then stratified by severity of injury across county-level characteristic categories such as ruralness, Distressed Communities Index, and concealed carry weapons permit rates.

Of 123,484 firearm injuries reported, 109,745 were intentional and 13,739 were unintentional. Since the late 1990s intentional firearm-related deaths and hospitalizations have increased over time, with higher rates in socioeconomically at-risk and larger counties. Unintentional nonfatal hospitalizations have increased exponentially, with higher rates in distressed counties, but no effects of county size or ruralness. Unintentional deaths declined over time, with no significant county-level effects. Based on heatmap patterns, White citizens appear to be victims of more intentional firearm injuries in rural areas, while Black citizens were victims of more intentional firearm injuries in urban areas. The rate of concealed carry weapons permit holders did not correlate to changes in unintentional firearm injury rates or intentional firearm injury rates but patterns can be identified on a county-by-county basis.

These results suggest that firearm deaths remain a problem in all Florida county communities, while hospitalizations are highly influenced by socioeconomic factors and county size. Heatmaps may inform level I trauma hospitals to implement tailored education for high-risk surrounding communities.