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Cited by 285Gun Ownership and Violence ResearchInjury Epidemiology and PreventionHomicide, Infanticide, and Child Abuse

Epidemiologic trends in fatal and nonfatal firearm injuries in the US, 2009-2017.

Open access
Kaufman, Elinore J., Wiebe, Douglas J., Xiong, Ruiying Aria, Morrison, Christopher N., Seamon, Mark J., Delgado, M. Kit·2021·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2020.6696PMC PMC7851729
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Abstract

Importance: Firearm injury research in the US has focused on fatal injuries. The incidence and epidemiologic factors associated with nonfatal firearm injuries are less understood. Objective: To evaluate estimates of incidence and trends over time of fatal and nonfatal firearm injuries. Design, Setting, and Participants: A cross-sectional, ecologic study was conducted using data throughout the US from 2009 to 2017. Data on fatal injuries from the Centers for Disease Control and Prevention were combined with national data on emergency department visits for nonfatal firearm injury from the Nationwide Emergency Department (ED) sample. Data analysis was conducted from August 2019 to September 2020. Exposures: Firearm injuries identified with International Classification of Diseases external cause of injury codes and categorized by intent of injury, age group, and urban-rural location. Main Outcomes and Measures: Incidence, case fatality rate, and trends over time of firearm injury according to intent, age group, and urban-rural location. Results: From 2009 to 2017, there was a mean of 85 694 ED visits for nonfatal firearm injury and 34 538 deaths each year. An annual mean of 26 445 deaths (76.6%) occurred outside of the hospital. Assault was the most common overall mechanism (38.9%), followed by unintentional injuries (36.9%) and intentional self-harm (19.6%). Self-harm, which accounted for 21 128 deaths (61.2%), had the highest case fatality rate (89.4%; 95% CI, 88.5%-90.4%), followed by assault (25.9%; 95% CI, 23.7%-28.6%) and legal intervention (23.4%; 95% CI, 21.6%-25.5%). Unintentional injuries were the most common nonfatal injuries (43 729 [51.0%]) and had the lowest case fatality rate (1.2%; 95% CI, 1.1%-1.3%). Self-harm deaths, 87.8% of which occurred outside the hospital, increased in all age groups in both rural and urban areas during the study period and were most common among people aged 55 years and older. The rate of fatal assault injuries was higher in urban than in rural areas (16.6 vs 9.0 per 100 000 per year) and highest among people aged 15 to 34 years (38.6 per 100 000 per year). Rates of unintentional injury were higher in rural than in urban areas (18.5 per 100 000 vs 12.4 per 100 000). Conclusions and Relevance: In this cross-sectional study, suicide appears to be the most common cause of firearm injury death in the US, and most people who die from suicide never reach the hospital. These findings suggest that assaults and unintentional injuries account for most nonfatal and overall firearm injuries and for most of the injuries that are treated in hospitals.

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  • Two proxy measures commonly used in the existing literature are ED visits and time between firearm injury encounters.

    “Two proxy measures commonly used in the existing body of literature are (1) ED visits and (2) time between firearm injury encounters.2,4-9”

    From Machine learning classification of new firearm injury encounters in the St Louis region: 2010-2020 (2024) · cites this paper as [2]

    The Abstract and the section on data sources show that this paper uses emergency department visits to estimate nonfatal firearm injuries and describes earlier work using ED data. The passages do not identify time between firearm injury encounters as a measure used in the literature; searches for that phrase and for proxy measures found no such discussion. (LLM, conf=0.86)

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  • The study patients experienced much higher rates of non-fatal firearm injuries than reported elsewhere; the fatal to non-fatal firearm injury rate was 1:14 in the index injury population and 1:7 in the recurrent injury population, compared to rates of 1:2 reported elsewhere.

    “Additionally, our patients experienced much higher rates of non-fatal firearm injuries than reported elsewhere; the fatal to non-fatal firearm injury rate was 1:14 in the index injury population and 1:7 in the recurrent injury population, compared to rates of 1:2 reported elsewhere.10,31”

    From Incidence of and Factors Associated With Recurrent Firearm Injury Among Patients Presenting to St. Louis Trauma Centers, 2010 to 2019 (2023) · cites this paper as [10]

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Authors
Kaufman, E. J., Wiebe, D. J., Xiong, R. A., Morrison, C. N., Seamon, M. J., & Delgado, M. K.
Affiliations
  • University of Pennsylvania (US)
  • Columbia University (US)
Corresponding author
Kaufman, Elinore J.
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2021-02-01
Volume
181
Issue
2
Pages
237
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2020.6696
PMC
PMC7851729
OpenAlex
W3112786647
Cited by
285
References
38
Citations by year
2026: 45 · 2025: 58 · 2024: 54 · 2023: 53 · 2022: 53 · 2021: 22
FWCI
17.72
Type
journal article
Language
en
Open access
Locations
  • JAMA Internal Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Child Health and Human Development
Topics
  • Social Sciences › Health › Gun Ownership and Violence Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Injury Epidemiology and Prevention
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
Keywords
firearm injuries, nonfatal firearm injuries, case fatality rate, intentional self-harm, firearm assault, unintentional firearm injury, emergency department visits, urban-rural disparities, injury trends
MeSH terms
Physical Abuse, Suicide, Completed, Adolescent, Adult, Child, Child, Preschool, Cross-Sectional Studies, Female, Firearms, Homicide, Humans, Infant, Infant, Newborn, Male, Middle Aged, United States, Wounds, Gunshot, Young Adult

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