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Beyond the Index: Family Fragility as a Geographic Risk Factor for Pediatric Firearm Injuries
Caitlin Rempson1, Etienne Pracht2, Alyssa Green3
1Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
Purpose:
Pediatric firearm injuries are associated with geographic social determinants of health (SDOH), but SDOH metrics may have limited explanatory power and actionability. "Family fragility," defined as the degree of disruption of family structures in a geographic area, may be an underrecognized driver of firearm injury disparity. This study evaluated the impact of family fragility on population-adjusted pediatric firearm hospitalizations in the context of other geographic SDOH.
Methods:
All patients aged 0-19 hospitalized with firearm injuries from 2012 to 2021 in Florida were obtained from a statewide database. Incidence of firearm hospitalizations per 100 k age-matched population was calculated for the state and each of its 67 counties. Multivariable linear regression quantified county-level risk factors for firearm injury hospitalization, including social vulnerability index components (socioeconomic status, household composition, minority status/language, housing type/transportation), rural vs. urban, and family fragility (non-marital births, divorces involving minors).
Results:
Overall, 3887 patients (mean age 16, 87 % male) were hospitalized with firearm injuries during the study period. The overall age-matched incidence of firearm injury hospitalization was 8.2 events per 100 k person-years but varied widely by county, ranging from 0 to 24. On multivariable linear regression, family fragility, rurality, and two SVI components (socioeconomic and housing/transportation) were significant independent predictors of firearm hospitalizations. Risk factors differed for self-harm vs. non-self-harm injuries.
Conclusion:
Pediatric firearm injury hospitalizations are associated with family fragility measures as well as rurality and other established SDOH factors. Self-harm injuries have a different risk factor profile. Future studies should validate these findings and investigate best practices for strengthening fragile families.
Type Of Study:
Original research; epidemiologic study.
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