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Firearm-related deaths in Tennessee children
Anthony W Strode1, Molly Golladay2, Shilin Zhao3
1Meharry Medical College School of Medicine, Nashville, Tennessee, USA.
Insights
Pediatric firearm deaths, particularly homicides, are rising among older children and Black youth in Tennessee. Lower neighborhood opportunity is linked to increased homicide risk, highlighting disparities in firearm injury outcomes.
Area of Science:
- Public Health
- Epidemiology
- Forensic Pathology
Background:
- Pediatric firearm injuries present a growing public health crisis with increasing mortality.
- Existing research often relies on hospital data, necessitating broader analyses of mortality indicators.
- This study examines firearm-related deaths among children using data from the Tennessee Chief Medical Examiner (CME).
Purpose of the Study:
- To investigate mortality indicators and disparities in pediatric firearm-related deaths.
- To analyze demographic, injury patterns, and geographic factors associated with child firearm fatalities.
- To identify trends in firearm-related homicides and suicides among children in Tennessee.
Main Methods:
- Retrospective cross-sectional study of 643 pediatric firearm death certificates (ages 0-17) from the Tennessee CME (2012-2022).
- Analysis of death certificate demographics, autopsy findings for injury patterns, and geocoded residential data using the Child Opportunity Index (COI).
- Statistical analysis including Pearson, Kruskal-Wallis, Wilcoxon, and linear regression modeling.
Main Results:
- Significant increases in pediatric firearm homicides (n=369) and suicides (n=202) were observed over the study period.
- Firearm deaths were more prevalent in older children (median age 16), with most homicides affecting Black youth and suicides affecting white youth.
- Lower COI levels correlated with a higher risk of homicide, and head wounds were common across all firearm death manners.
Conclusions:
- Homicide rates have increased and remain the predominant manner of firearm death among children in Tennessee.
- Findings highlight age- and manner-specific disparities in lethal firearm injuries, emphasizing the need for targeted interventions.
- The study underscores the link between socioeconomic factors, race, and firearm violence impacting children.
Background:
The healthcare burden and fatality rate associated with pediatric firearm injuries is increasing substantially. Most published studies evaluating outcomes and disparities of pediatric firearm-related injuries have focused primarily on hospital-level data. This study aimed to investigate mortality indicators among pediatric decedents referred to the Tennessee Chief Medical Examiner (CME) having a confirmed firearm-related cause of death.
Methods:
In this retrospective cross-sectional study, the Tennessee CME database was queried to reveal 643 death certificates of children ages 17 years and younger who died from a firearm-related injury between 2012 and 2022. Death certificates were surveyed for demographics and residential data. Autopsy reports were reviewed for anatomic injury patterns. The neighborhood of residence for each decedent was geocoded for analysis using the Child Opportunity Index (COI). Pearson, Kruskal-Wallis, Wilcoxon, and linear regression modeling were completed.
Results:
Significant increases in both homicide (n=369; p<0.0001) and suicide (n=202; p=0.001) were documented over time. Firearm deaths increased with age (median age, 16.0 years; IQR (13-17)), with ≥70% of homicide and suicide cases occurring between ages 15 years and 17 years. 272 homicide decedents (76%) were black, and 165 (82%) suicides were white (p<0.001). Over half of decedents sustained a head wound (p<0.001). Geocoded density maps indicated a correlation between pediatric population race density and predominating manners of firearm death. Residences with a lower COI level were associated with a higher risk of homicide.
Conclusion:
In this query of the Tennessee CME registry, homicide rates increased and remained higher than all other firearm manners of death impacting children. This study revealed opportunities to affect meaningful change regarding different ages and manners of lethal firearm injuries among children.
Level Of Evidence:
III.
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