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Pediatric Firearm-Related Hospital Encounters by Child Opportunity Index Level

Gwyneth A Sullivan1,2, John Sincavage2, Yao Tian1,3

  • 1Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.

Pediatrics
|August 24, 2025
PubMed

Insights

Pediatric firearm injury hospitalizations are higher in areas with lower childhood opportunity. Unintentional injuries were the most common cause across all opportunity levels.

Area of Science:

  • Public Health
  • Epidemiology
  • Social Determinants of Health

Background:

  • Neighborhood social determinants of health (SDOH) impact pediatric health outcomes.
  • The association between neighborhood SDOH and pediatric firearm-related injury hospital encounters has not been fully assessed statewide.
  • Childhood Opportunity Index (COI) is a measure of neighborhood-level SDOH.

Purpose of the Study:

  • To determine the relationship between zip code-level COI and the incidence of pediatric firearm-related injury hospital encounters.
  • To analyze this relationship across four geographically representative states.

Main Methods:

  • Retrospective observational cohort study using 2016-2021 discharge data from Florida, Maryland, New York, and Wisconsin.
  • Combined discharge data with COI 3.0 zip code data.
  • Compared zip code incidence rate ratios of pediatric firearm-related injury hospital encounters by COI quintile.

Main Results:

  • 6896 pediatric firearm-related injury hospital encounters were identified.
  • Hot spots of pediatric firearm-related injury hospital encounters were more prevalent in very low COI zip codes (28.4%) compared to very high COI zip codes (5.5%).
  • The incidence rate ratio of pediatric firearm-related injury hospital encounters decreased with increasing COI quintiles across all four states.

Conclusions:

  • Pediatric firearm-related injury hospital encounters increase as childhood opportunity decreases.
  • Unintentional injuries represent the largest proportion of firearm-related injuries across all COI levels.
Abstract

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