Online Program

Epidemiology of fatal and non-fatal firearm injuries in the US, 2001-2013

Monday, November 2, 2015

Chandana Adhikarla, M.S.Surgery, M.P.H., Department of Epidemiology, Columbia University, Bloomington, IL
Joyce C. Pressley, PhD, MPH, Depts of Epidemiology and Health Policy and Management, Center for Injury Epidemiology and Prevention at Columbia, Columbia University, New York, NY
Jeffrey Fagan, Ph.D., Law School, Columbia University, New York, NY
Sandro Galea, MD, DrPH, School of Public Health, Boston University School of Public Health, Boston, MA
Bindu Kalesan, PhD, MPH, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
Background:Fatal-firearm injury rates in US remained stable, although hospitalizations declined in the previous decade. To characterize these trends across age, gender, race/ethnicity and intent, we examine overall and subgroup-specific temporal trends for fatal and non-fatal firearm injuries in US from 2001-2013.

Methods: Counts of fatal and non-fatal firearm injuries were obtained from CDC’s WISQARS database. Injuries classified by type as fatal (F), non-fatal released from emergency department (NF-ED) or non-fatal hospitalized (NF-HS); race/ethnicity as non-Hispanic-white, black, Hispanic (excluding blacks) and other-race; intent as homicide (or assault)/legal-intervention, suicide and unintentional (includes undetermined). Poisson regression was used to analyze overall and subgroup-specific temporal trends, assuming linear trends. Rates per 100,000 persons and annual-change in rates were estimated.

Results: Across 13 years, no change was observed in overall firearm-fatalities (annual-change=0.015; p-trend=0.22) and NF-ED injuries (annual-change=0.07; p-trend=0.20) while NF-HS increased (annual-change=0.28, p-trend<0.0001). Rates increased in ages 15+, driven by NF-HS (annual-change=0.83, p-trend<0.0001). Overall firearm injury trends, increased among whites (annual-change=0.28, p-trend<0.0001) and decreased among other-race (annual-change=-0.46, p-trend=0.006). Fatalities declined among all race/ethnicities but increased in non-Hispanic white. Temporal trends differed by intent (p-interaction<0.0001). Among homicides, fatal injuries declined while NF-HS and NF-ED increased. Firearm-suicides increased, predominantly fatal-suicides in whites (annual-change=0.162, p-trend<0.0001). Unintentional firearm injury rates declined across 13 years.

Conclusions Overall, US firearm injury rates increased from 2001-2013, driven by increasing rate of non-fatal firearm-hospitalizations. Though general trends demonstrate an increase among whites, a decrease among other-race and no significant change among blacks and Hispanics, these rates mask wide variations by intent and injury type.

Learning Areas:

Advocacy for health and health education
Public health or related laws, regulations, standards, or guidelines
Public health or related research

Learning Objectives:
Demonstrate trends in fatal and non-fatal firearm injury rates in the United States between 2001 and 2013; To describe how rates differ by injury type across age, gender, race/ethnicity and intent of injury. Through this research and analysis we explained how, both fatal and non-fatal firearm injuries are part of one continuing spectrum of firearm related injuries and that the entire spectrum needs to be assessed, considered and given importance to, when analyzing and reporting on the public health burden of firearm injuries. Accordingly, we have classified firearm injuries according to their disposition as non-fatal ED (injuries that get treated and released from the emergency department), non-fatal HS (injuries that require hospitalization) and firearm deaths which can be considered to be the severest of all. Of these it has been observed that firearm hospitalizations nationally have increased while fatalities remained stable over the last decade. Though this project we also describe rates across race/ethnicity using this classification: non-Hispanic white, blacks (include both Hispanic and non-Hispanic blacks without differentiation), Hispanic (which excludes Hispanic blacks) and other-race (which includes all other race/ethnicities).

Keyword(s): Violence & Injury Prevention, Epidemiology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an MPH graduating student in transition from Department of Epidemiology with a certificate in Injury Prevention and Control, at the Mailman School of Public Health, Columbia University, New York. This project in firearm injury research is my Master’s thesis work for the MPH degree. I am also a surgeon by training from India with special interest in Trauma and Emergency Surgery.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.