Variation in pediatric and adolescent firearm mortality rates in rural and urban US counties.

TitleVariation in pediatric and adolescent firearm mortality rates in rural and urban US counties.
Publication TypeJournal Article
Year of Publication2010
AuthorsNance ML, Carr BG, Kallan MJ, Branas CC, Wiebe DJ
JournalPediatrics
Volume125
Issue6
Pagination1112-8
Date Published2010 Jun
ISSN1098-4275
KeywordsAdolescent, Child, Female, Firearms, Homicide, Humans, Male, Rural Population, Suicide, United States, Urban Population, Wounds, Gunshot
Abstract

OBJECTIVE: We examined whether firearm mortality rates among children varied across US counties along a rural-urban continuum.

METHODS: US vital statistics data were accessed for all pediatric (age: 0-19 years) firearm deaths from 1999 through 2006. Deaths were analyzed according to a modified rural-urban continuum code (based on population size and proximity to metropolitan areas) assigned to each county (3141 counties).

RESULTS: In the 8-year study period, there were 23649 pediatric firearm deaths (15190 homicides, 7082 suicides, and 1377 unintentional deaths). Pediatric nonfirearm mortality rates were significantly higher in the most-rural counties (adjusted rate ratio: 1.36 [95% confidence interval [CI]: 1.13-1.64]), compared with the most-urban counties. The most-rural counties demonstrated virtually identical pediatric firearm mortality rates (adjusted rate ratio: 0.91 [95% CI: 0.63-1.32]), compared with the most-urban counties. The most-rural counties had higher rates of pediatric firearm suicide (adjusted rate ratio: 2.01 [95% CI: 1.43-2.83]) and unintentional firearm death (adjusted rate ratio: 2.19 [95% CI: 1.27-3.77]), compared with the most-urban counties. Pediatric firearm homicides rates were significantly higher in the most-urban counties (adjusted rate ratio: 3.69 [95% CI: 2.00-6.80]), compared with the most-rural counties.

CONCLUSIONS: Children in the most-rural US counties had firearm mortality rates that were statistically indistinguishable from those for children in the most-urban counties. This finding reflects a greater homicide rate in urban counties counterbalanced by greater suicide and unintentional firearm death rates in rural counties. Nonfirearm mortality rates were significantly greater outside the most-urban US counties.

DOI10.1542/peds.2009-3219
Alternate JournalPediatrics
PubMed ID20498168