Stricter gun laws associated with lower firearm injury rates in youth

Monika Goyal

CHICAGO — Regions of the United States with the strictest gun laws also had the lowest rates of ED visits for firearm injuries among children and adolescents, according to research presented at the 2017 American Academy of Pediatrics National Conference and Exhibition.

“Firearm-related injuries are a leading cause of morbidity and mortality among children and adolescents. States with more restrictive gun laws have fewer firearm-related pediatric fatalities,” Monika Goyal, MD, MSCE, director of research in the division of emergency medicine at Children’s National Health System and assistant professor of pediatrics and emergency medicine at George Washington University, and colleagues wrote.

Goyal and colleagues performed a repeated cross-sectional analysis to determine the association between regional firearm legislation and pediatric firearm-related injuries presenting to the ED using data from the Nationwide Emergency Department Sample from 2009 to 2013.

The researchers used annual census data to estimate national rates of firearm-related ED visits in children and adolescents under the age of 21 years. Trends in visits were evaluated over time and by geographic region (Northeast, South, West and Midwest). The researchers calculated median regional scores for firearm legislation using the state-level Brady Gun Law Score. Higher median scores indicated stricter gun laws.

The researchers identified 111,839 ED visits for pediatric firearm-related injuries. Mean patient age was 18 years, 89.3% of patients were male and 38.5% were publicly insured.

Approximately 6% of ED visits resulted in death, while 30% resulted in hospital admission. A consistent rate of 65 firearm-related ED visits per 100,000 pediatric ED visits was seen during most of the study period aside from 2013 when there was a slight decline to 51 per 100,000.

The highest median Brady Gun Law Score was in the Northeast region (45), followed by the Midwest and West regions (9 for both) and the South (8). When comparing the regions’ Brady Gun Law Score to the number of ED visits for pediatric firearm-related injuries, Goyal and colleagues found that the regions with higher scores had lower rates of pediatric ED visits for firearm injuries.

During the study period, there was a decrease in firearm injury rates in the Northeast. The lowest rate of firearm injuries was in the Northeast region (40 pediatric firearm injuries per 100,000 ED visits), followed by the Midwest (62 pediatric firearm injuries per 100,000 ED visits) and West (68 pediatric firearm injuries per 100,000 ED visits). The South had the highest rate of pediatric firearm injuries (71 per 100,000 ED visits).

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The likelihood of firearm related ED visits was higher in the South (adjusted OR = 1.8; 95% CI, 1.4-2.3) and West (aOR = 1.7; 95% CI, 1.3-2.2) than in the Northeast. No overall or regional differences in mortality rates over time were observed.

“To our knowledge, this is the first study to demonstrate regional variation in ED visits for pediatric firearm-related injury and to characterize the association between strictness of firearm legislation and pediatric injury rates,” Goyal told Healio Internal Medicine. “The bottom line: Regions of the United States with stricter gun laws had lower rates of ED visits for pediatric firearm-related injuries.

“Our firearms research group has an overarching interest in raising awareness about this public health issue. All of us are pediatricians, and most of us are parents,” she continued. “So, we are acutely aware of the number of children who suffer injuries or who die due to firearm-related injuries. In addition to raising awareness, we want to empower pediatricians and hospitalists to get involved in efforts that strive to reduce firearm-related injuries among children in this country.”

Goyal noted that there are several ways primary care physicians can get involved.

“On the patient level, we can ask patients and families about firearm access, and we can encourage safe storage of firearms in the home,” she said. “Additionally, we can encourage our families to ask about firearm access and storage practices when their child will be at a playdate or at another caretaker’s or relative’s home. Second, we can educate trainees on firearm-related injuries and how to counsel families about safe weapon storage. Third, we can support and/or undertake research and inform policy efforts in this area.” – by Alaina Tedesco

Reference:

Goyal M, et al. Geographic regions with stricter gun laws have fewer emergency department visits for pediatric firearm-related injuries: A five-year national study. Presented at: American Academy of Pediatrics National Conference and Exhibition; Sept. 16-19, 2017; Chicago.

Disclosure: Healio Internal Medicine was unable to confirm relevant financial disclosures at the time of publication.