Adolescent firearm injury trends at a Level I trauma center in Washington State, USA, 2011-2021

Firearm-related harm is a pressing public health problem in the United States, particularly among adolescents. While informative, national level data may mask variations in firearm injury incidence across and within states.Publicly available firearm injury data may be limited or unavailable, highlighting the importance of analyzing more granular data to develop or refine tailored interventions shaped by the unique needs and contexts of individual communities.

This retrospective cohort study used data from a Level I Trauma Center and death records to examine adolescent firearm injury trends in King County, Washington from 2011 to 2021. We calculated incidence rates per 100,000 population for each year of the study period and examined differences by fatality, intent, race, ethnicity, age, and sex.

Annual incidence rate of overall firearm injury significantly increased during the study period from 18.1 to 24.9 per 100,000 persons (p = 0.003); we observed the highest rate in 2020 (26.5 per 100,000 persons) and the lowest in 2013 (11.5 per 100,000 persons). Nonfatal firearm injuries comprised 71.4% of our sample and had the highest rate in 2020 (18.7 per 100,000 persons), while the rate of fatal firearm injuries was highest in 2021 (8.0 per 100,000 persons). Assault-related firearm injuries were most frequent (73.7%), were primarily nonfatal (81.7%), and significantly increased during the study period (p < 0.001). The rate of self-inflicted injuries surpassed that of unintentional injuries during the study period and the majority were fatal (92.5%). Overall firearm injury incidence rates were highest among adolescents aged 18-19, males, and individuals from racial or ethnic minority groups.

The rate of firearm injuries among King County adolescents significantly increased between 2011 and 2021. Our study identified a disproportionate burden of firearm-related harm among King County adolescents who are Black, American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, Latine, male, and aged 18-19, highlighting disparities in firearm injury by demographic subgroups. These findings may assist the development of local evidence-informed prevention and intervention strategies and guide the implementation of existing interventions among adolescents disproportionately impacted by firearm-related harm.