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States with stricter gun laws have fewer pediatric firearm-related deaths
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A 5-year analysis in the United States revealed that states with stricter gun laws, including those that require universal background checks for gun purchases, have fewer pediatric firearm-related deaths.
“More than 10 U.S. children die from firearm-related injuries every day, and another 50 kids suffer firearm-related injuries daily," study researcher Monika K. Goyal, MD, MSCE, director of research in the division of emergency medicine and trauma services at Children’s National Health System, told Infectious Diseases in Children. “This phenomenon is unique to our country. The U.S. has the highest rates of firearm-related injuries among children compared with any other industrialized country.”
Goyal and colleagues wrote that three state laws — universal background checks for firearm purchases, universal background checks for ammunition purchases, and identification requirements for firearms — were previously linked to a decline in firearm-related deaths.
The researchers assessed data collected from pediatric firearm-related deaths between 2011 and 2015 using the CDC’s Web-Based Injury Statistics Query and Reporting System.
The study, which builds on results initially presented at Pediatric Academic Societies 2018 Meeting, showed that a total of 21,241 children died from firearm-related injuries during the study period. In their analysis, the researchers found that states that enacted stricter firearm legislation had lower rates of pediatric firearm-related mortality (adjusted incident rate ratio [IRR] = 0.96; 95% CI, 0.93-0.99) compared with states with more lenient firearm legislation. Furthermore, states that had legislation requiring universal background checks that were in place for 5 years or more had lower rates of pediatric firearm-related mortality (aIRR = 0.65; 95% CI, 0.46-0.9).
“As pediatricians, we are on the front lines of the firearm epidemic as we care for children, families and communities that have been affected by gun violence,” Goyal said. “We know that firearm injuries are not just physical. There are long-lasting psychosocial consequences as well. It is our job as pediatricians to continue to advocate for the safety of our children by counseling families we care for about gun safety and testifying on their behalf to policymakers.”
In a related editorial, Lois K. Lee, MD, MPH, senior associate in medicine at Boston Children’s Hospital, and Judy Schaechter, MD, MBA, chief of service at Holtz Children’s Hospital, described gun violence as a “disease that disproportionately affects children and youth with differing presentations on the basis of developmental stage, intent, environment and circumstance.”
To address the problem, “we must move beyond ‘thoughts and prayers’ as well as our current research limitations,” they continued. “We need policy informed by research on gun laws detailing the subtypes of this fatal yet preventable disease. Only then can we move forward in promoting stronger policies to stay, or ideally, reverse the current course of increasing gun deaths to protect people of all ages, most especially our children and youth.” – by Katherine Bortz
References:
Goyal MK, et al. Pediatrics. 2019;doi;10.1542/peds.2018-3283.
Lee LK, Schaechter J. Pediatrics. 2019;doi:10.1542/peds.2019-1300.
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Patrick Carter, MD
Firearm injuries are the second leading cause of death among U.S. children and adolescents, resulting in over 3,000 fatal and 18,000 nonfatal firearm injuries every year. Increases in firearm homicide and suicide rates, as well as increases in the number of school shootings during the past decade, have raised public awareness about this issue and focused greater attention on how firearm policies might work to decrease pediatric firearm deaths.
The recent study by Goyal and colleagues analyzed 5 years of repeated cross-sectional mortality data collected between 2011 and 2015, finding that states with stricter firearm legislation (measured using a composite grading score) had lower rates of pediatric firearm mortality. Specifically, for every 10-point increase in the firearm legislation score, the authors found there was a 4% decrease in the pediatric mortality rate, even after adjusting for potential confounding variables — including firearm ownership. Further, the analysis found that states with universal background checks governing firearm purchases in effect for more than 5 years had lower rates of pediatric firearm mortality.
The analysis has several limitations, including the use of cross-sectional data that precludes causal attributions. In addition, the study examines only a limited number of policies that may influence pediatric mortality and did not examine how changes in state policies over time may impact pediatric mortality. Despite these limitations, the study has important implications for future public policies, including finding that increasing the strength of firearm policies may be an effective approach to decreasing pediatric firearm deaths, including in regions with high levels of firearm ownership. More research is needed to tease apart which of these individual policies are most effective in improving pediatric-specific outcomes, as well as how such policies may be combined and implemented effectively to have maximal impact.
Pediatricians should be aware of such research findings so that they may better advocate for state firearm policies within their communities. These findings can also help pediatricians advocate for future rigorously conducted research to identify additional individual-, community- and policy-oriented interventions to improve firearm safety, as well as address the staggering morbidity and mortality associated with this public health problem.
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