Study: Recurrent firearm injuries most common in young, Black men

Key takeaways:

• Among those with recurrent firearm injuries, 96% were Black individuals.
• The ACP has an online hub that offers resources to internal medicine physicians for the prevention of firearm injuries and death.

Firearm injury survivors often experienced recurrent firearm injuries, particularly those who were young, uninsured, male and Black, according to a study recently published in Annals of Internal Medicine.

Firearm injuries continue to rise in the United States. Previous research has shown that ED visits due to firearm-related injuries in 2022 were 20% higher compared with rates from 2019. However, the U.S. does not have a comprehensive database of fatal and nonfatal firearm injuries, Kristen L. Mueller, MD, an associate professor of emergency medicine at Washington University School in St. Louis, and colleagues wrote.

“Consequently, reported rates of nonfatal firearm injuries at twice that of fatal firearm injuries may be an underestimate,” they wrote. “A growing body of literature highlights the need for cross-sector data sharing and comprehensive data on firearm injury to support violence reduction.”

The researchers conducted a study to establish the incidence of recurrent firearm injuries and deaths, as well as factors associated with recurrent injuries. The analysis included data from the St. Louis Region-Wide Hospital-Based Violence Intervention Program (HVIP) repository on 10,293 adult and pediatric patients who presented with a firearm injury to a St. Louis level 1 trauma hospital from 2010 to 2019. Among them, 9,553 survived the injury.

Mueller and colleagues also used the CDC’s Social Vulnerability Index (SVI) and Census data to analyze patients’ social determinants of health.

“For each Census tract, the SVI represents the percentile of social vulnerability relative to all other Census tracts in the United States,” they wrote. “The SVI was categorized based on quartiles into low (SVI <0.25), average (SVI between 0.25 and 0.75), and high (SVI >0.75) social vulnerability.”

Over a median follow-up period of 3.5 years, the researchers reported that 1,155 patients suffered a recurrent firearm injury. Patients with recurrent injuries had a mean age of 25 years, whereas:

• 93% were men;
• 96% were Black individuals;
• 50% were uninsured; and
• 65% lived in a high SVI region.

The estimated risk for recurrent firearm injury was 7%, 13% and 17% at 1 year, 5 years and 8 years after the initial injury, respectively.

The study revealed greater rates of nonfatal firearm injuries than other reports, with five firearm suicides and 149 fatal firearm injuries among all patients with a recurrent firearm injury, according to the researchers.

“The fatal-nonfatal firearm injury rate was 1:14 in the index injury population and 1:7 in the recurrent injury population, compared with rates of 1:2 reported elsewhere,” they wrote.

Mueller and colleagues highlighted the racial disparity observed in the study, noting that “communities of color with high numbers of ethnic and racial groups that experience structural racism due to the enactment of current and historical policies that can lead to racial segregation, over-policing, restriction in access to services, and overall community disinvestment experience higher rates of firearm violence.”

The researchers suggested that substance use disorder screenings during hospital discharge, follow-up clinical visits and HVIP patient engagement could help identify firearm injury survivors who may benefit from treatment.

“Accidental overdose prevention in this cohort could include co-prescription of naloxone for patients who require opioids, and counseling on the risks for developing substance use disorder as a sequela of the physical and mental burden of firearm injury,” they wrote. “Health care providers can also provide anticipatory guidance on safe firearm storage practices (for example, use of a gun safe with bullets stored in a different physical location) to mitigate the risk for subsequent firearm suicide and accidental death.”

Earlier this year, the ACP launched an online hub for internal medicine physicians that offers resources for the prevention of firearm injuries and deaths. The hub consolidates the ACP’s articles and position papers published in Annals of Internal Medicine, along with videos that provide tips on discussing firearm safety with patients. It also includes links to a collection of personal stories related to gun violence and a health care professionals’ pledge to discuss firearm safety with their patients.

References:

• Mueller K, et al. Ann Intern Med. 2023;doi:10.7326/M23-0069.
• Preventing firearms-related deaths and injuries. https://www.acponline.org/about-acp/who-we-are/preventing-firearms-related-deaths-and-injuries-information-for-internal-medicine-physicians. Accessed Aug. 28, 2023.