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A multi-decade joinpoint analysis of firearm injury severity
  1. Bindu Kalesan1,
  2. Yi Zuo1,
  3. Ziming Xuan2,
  4. Michael B Siegel2,
  5. Jeffrey Fagan3,
  6. Charles Branas4,
  7. Sandro Galea5
  1. 1 Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Boston University School of Medicine, Boston, Massachusetts, USA
  2. 2 Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
  3. 3 Department of Law and Epidemiology, Columbia University, New York City, New York, USA
  4. 4 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York, USA
  5. 5 Dean’s Office, Boston University School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Bindu Kalesan, Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Boston University School of Medicine, Boston, MA 02118, USA; kalesan{at}bu.edu

Abstract

Background Non-fatal firearm injuries constitute approximately 70% of all firearm trauma injuries in the United States. Patterns of severity of these injuries are poorly understood. We analyzed the overall, age-, sex- and intent-specific temporal trends in the injury severity of firearm hospitalizations from 1993 to 2014.

Methods We assessed temporal trends in the severity of patients hospitalized for firearm using Nationwide Inpatient Sample (NIS) data over a 22 year period. Firearm hospitalization was identified using assault (E965x), unintentional (E922x), intentional self-harm (E955x), legal (E970) and undetermined (E985x) International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9) codes. Injury severity was measured using the computed New Injury Severity Score (NISS). We used survey weighted means, SD and annual percent change (APC), and joinpoint regression to analyze temporal trends.

Results A weighted total of 648 662 inpatient admissions for firearm injury were analyzed. Firearm injury severity demonstrated a significant annual increase of 1.4% (95% CI=1.3 to 1.6), and was driven by annual increases among young adults (APC=1.4%, 95% CI=1.3 to 1.5), older adults (APC=1.5%, 95% CI=1.3 to 1.6), female (APC=1.5%, 95% CI=1.3 to 1.6) and male (APC=1.4%, 95% CI=1.3 to 1.6) hospitalizations. The annual increase among assault/legal injuries was 1.4% (95% CI=1.3 to 1.5), similar to unintentional (APC=1.4%, 95% CI=1.3 to 1.6), intentional self-harm (APC=1.5%, 95% CI=1.4 to 1.6) and undetermined (APC=1.4%, 95% CI=1.3 to 1.6).

Conclusions The severity of hospitalized firearm injuries increased significantly from 1993 to 2014. This annual increase reflects a move towards hospitalization of more serious injuries, and outpatient management of less serious injuries across the board, suggesting a mounting burden on the US healthcare system.

Level of evidence Level IV.

  • injury severity
  • injury
  • time trends

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • This was presented at the APHA Annual Meeting and Expo —‘Creating the Healthiest Nation: Climate Changes Health’, Atlanta, GA, Nov 7, 2017.

  • BK and YZ contributed equally.

  • Contributors BK, YZ and SG conceived and supervised the study. YZ and BK completed the analyses. BK, YZ, ZX, MBS, JF, CB and SG led the writing and revisions of the manuscript. YZ assisted with obtaining data and performed data management.

  • Competing interests None declared.

  • Ethics approval Boston University IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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