Demographic and Social Factors Associated With Pediatric Firearm Injuries: A Retrospective Review

To identify demographic, social, and legislative risk factors that may contribute to increased incidence of ballistic injuries among children presenting to Le Bonheur Children's Hospital (LBCH) in Memphis, Tennessee. Memphis has the highest incidence of violent crime per capita in the United States. Tennessee, where Memphis is located, became a permit-less carry state on July 1, 2021.

We conducted a retrospective cohort study of firearm-related injuries among pediatric patients (0 to 18 y) who presented to Le Bonheur Children's Hospital (LBCH)-a tertiary care hospital and ACS-verified Level 1 Pediatric Trauma Center-from January 1, 2010, through December 31, 2023. Variables collected included age, sex, race, mortality, school zoning type (in-person, virtual, hybrid), Social Vulnerability Index (SVI) (based on patient residence), and first firearm injury (in the event patients experienced more than one). Statistical analyses were performed using the T test, χ 2 test, univariate and multivariate Poisson regression, and backward elimination.

From 2010 to 2023, we collected 1512 charts featuring 1471 individual subjects; 79.13% were males, 78.11% were Black, and 56.8% were 14 to 18 years old. The number of pediatric firearm injuries increased from 153 patients in September 2018 to February 2020, to 377 patients between March 2020 and August 2021 during the pandemic, when schools closed and most students attended school online remotely. Black males, adolescents aged 14 to 18 years, and residing in a high-risk SVI area were associated with a higher risk of firearm injury. Passage of the permit-less carry legislation was associated with a 23.78% increase in firearm injuries. Black race and male sex were significant risk factors for firearm injury, while a low-risk SVI was protective.

This study shows that adolescents living in areas with high SVI who are Black and male are more likely to suffer firearm injuries. Because there is widespread poverty in Memphis and increased access to guns, firearm injuries will continue to be a major public health issue for this demographic. Research on this topic should lead to tangible efforts to improve these risk factors and reduce the number of firearm injuries.