Urban-Rural Divide On Pediatric Injuries from Firearms

We previously blogged about when gun violence victims receive care at community based/non-trauma facilities, so I was interested in a recent Pediatrics study that sought to compare hospitalization rates due to firearm injuries in rural versus urban settings among children and adolescents <20 years of age in the United States. 

Previous studies have examined firearm-related mortality rates among pediatric patients in rural and urban areas, but no other studies have analyzed hospitalization rates, nor have there been any studies comparing different pediatric age groups in rural and urban locations.

The researchers for this recent study analyzed data using the 2012 dataset (representing the years 2006, 2009, and 2012) from the Kids' Inpatient Database (KID), a publicly available, nationally representative, all-payer database of pediatric inpatient hospitalizations and discharges. The weighted data from this dataset represent over 7 million pediatric hospital discharges each year of the KID. Eligible hospitalizations for this analysis included fatal and nonfatal injuries stemming from firearms.

Intent of injury was specified as assault, self-inflicted, unintentional, and undetermined (and broadly categorized as unintentional or purposefully inflicted). Demographic information was categoried by age at the time of hospitalization, sex, race and/or ethnicity, type of health insurance, and patient's county of residence.

Counties were classified as:

• Rural (nonmetropolican nonmicropolitan counties of <10,000)
• Micropolitan (population 10,000-49,999)
• Urban (metropolitan counties of <50,000). 

What They Found

• More than 21,000 hospitalizations due to firearm injuries were identified and analyzed.
• The highest rate of hospitalization regardless of intent occurred among 15-19 year olds in urban areas (30 per 100,000 persons), and accounted for more than 75% of all pediatric firearm-related hospitalizations. 
  • The lowest rate of hospitalization occurred among 0-4 year olds in micropolitan areas (0.71 per 100,000 persons). 
• Compared to rural areas, hospitalization rates were statistically significantly higher in urban areas among 15 to 19 year olds (RR 2.76, 95% CI: 2-51-3.03) but lower in the 10- to 14-year-old and 5 to 9-year-old age groups.
  • There were no statistically significant differences among those 0 to 4 years old in urban or rural areas.
  •  Micropolitan and rural areas did not differ in rates in any of the age groups except for in the 10-14 year old group, which was less likely to be hospitalized in micropolitan areas compared to rural areas. 
• Firearm assaults were the leading cause of hospitalizations among 15 to 19 year olds in urban areas, and occurred at a rate of nearly 8 times that in the same age group in rural areas.
• Unintentional injuries were the leading cause of hospitalization for all the younger age groups in both urban and rural locations, and were statistically significantly lower in urban areas among 5-9 and 10-14 year olds compared to their same group in rural areas.
• Hospitalization due to self-inflicted injuries was highest in rural areas among 15 to 19 year olds and statistically significantly higher than in urban areas.  
• There were no differences in fatalities during hospitalization between urban and rural locations.

What This Means

The findings of this study reinforce what we know about the increased risk among African American and Hispanic youth in urban areas. Furthermore, the findings that the younger age groups in rural areas are at increased risk of unintentional injuries and that older youths in rural areas are at increased risk of self-inflicted injury suggest that approaches to reducing injuries in rural locations may need to additionally focus on strategies such as safe gun storage and suicide prevention.

This study provides new information towards understanding the different and complex factors that impact risk of firearm-related injuries based on residential location and could help to inform future injury prevention strategies. 

Read more about counseling families on gun safety and safe gun storage.

Watch a webinar for healthcare professionals on counseling families about gun safety

Read the study