National trends in nonfatal firearm-related injuries compared to deaths: Are firearm-related injury rates on the rise?

Purpose: To characterize trends in national estimates of nonfatal firearm-related (FA) injuries treated in US hospital emergency departments compared to firearm-related death rates. Methods: Nonfatal FA gunshot wound data for 1993-2005 from the CDC Firearm Injury Surveillance Study using the National Electronic Injury Surveillance System (NEISS) were analyzed. Narratives abstracted from the medical record were used to classify the intent of injury. FA death and FA homicide data for 1986-2004 from the National Vital Statistics System and homicide data for 1986-2005 from the FBI Uniform Crime Reports also were analyzed. Results: Preliminary data indicate that nonfatal FA injury rates declined from 1993 to 2002 and then increased from 2002-2005. In contrast, FA death and FA homicide rates declined from 1993-2000 but then remained relatively constant from 2001-2004. Overall, national estimates of nonfatal FA injuries increased 12.6% from 2002-2005; this increase was predominantly associated with males (14.1%), persons aged 15-34 years (22.6%), and FA assaults (37.0%). National estimates of nonfatal unintentional FA, self-harm FA, and undetermined FA injuries declined (i.e., -21%, -13.4%, and -34.3%, respectively) from 2002-2005. Conclusion: Assessment of trends in nonfatal FA injuries using NEISS data may provide a useful tool for early detection of a national increase in FA injuries. An increase in nonfatal FA injury rates versus relatively unchanged FA death rates after 2002 raises important research questions about the possible role of changes in the lethality of FA injuries and/or improvements in emergency care services in explaining diverging trends in fatal and nonfatal FA injury rates.