Citation

Lee LK, Schaechter J. Pediatrics 2019; 144(2): ePub.

Affiliation

Department of Pediatrics, University of Miami and Holtz Children's Hospital, Miami, Florida jschaechter@miami.edu.

Copyright

(Copyright © 2019, American Academy of Pediatrics)

DOI

10.1542/peds.2019-1300

PMID

31308260

Abstract

Firearm fatality rates in the United States among children and youth 1 to 24 years old have been increasing since 2013, after an overall decline from 1999 to 2012.1,2 The upward trend in pediatric firearm fatalities includes a 32% rise in firearm homicide and a 28% rise in firearm suicide rates.2 A better understanding of effective prevention, such as the role of legislation, is essential in addressing this growing public health crisis. In this issue of Pediatrics, Goyal et al3 analyze the association of pediatric firearm fatality rates with stricter state gun laws in aggregate and with a focus on 3 specific laws. These laws were selected on the basis of work by Kalesan et al,4 in which a multivariate Poisson regression model that included 25 different firearm laws was used to examine the association of these laws with reductions in firearm homicides and suicides. This regression model identified 3 laws associated with decreased firearm deaths: (1) universal background checks for firearm purchase, (2) background checks for ammunition purchase, and (3) firearm identification requirements with microstamping or ballistic fingerprinting.4 Building on this work, in the current study, Goyal et al3 conclude that stricter state firearm laws in aggregate, and universal background check laws for the purchase of firearms in particular, are associated with decreased firearm deaths in children and youth 0 to 24 years. There were insufficient numbers of states with the other 2 laws for meaningful analysis.

Gun death is the outcome of a disease with guns as the consistent mechanism, yet it is a disease with differing intents of injury (ie, unintentional, homicide, suicide, and legal intervention). Like other diseases, firearm injury presents at different rates and with different intents and circumstances across the pediatric age range.1,5–7 Thus, each age group may have different responses to the same legislation. An analysis of which specific laws may be most effective in curbing gun deaths for 0- to 24-year-old youth seeks to segregate children and youth from the general population. The age range in the Goyal et al3 study, inclusive of young adults, does reflect pediatric clinical practice; however, a more defined analysis by age group would be beneficial.

Rates of gun death are highest for youth 18 to 24 years old, followed by youth 13 to 17 years old. Because the intent and circumstances of firearm injuries vary with age ...

Language: en