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Abstract
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Firearm injuries are the leading cause of injury-related death for US children,1 and increased societal violence during the COVID-19 pandemic, including mass shooting events, has sparked renewed public attention toward this public health crisis. Some early pandemic studies revealed a spike in firearm injuries,2,3 whereas others found unchanged rates.4,5 We evaluated contemporary trends in pediatric firearm injuries before and during the pandemic to determine whether sociodemographic risk factors were similar.
Methods
This retrospective cohort study used data from the Pediatric Health Information System (PHIS), an administrative database that includes 49 tertiary care pediatric hospitals across the US. This study was approved by the University of Utah Institutional Review Board, which waived the informed consent requirement because deidentified were used. We followed the STROBE reporting guideline.
We included all children younger than 18 years diagnosed with firearm injury based on International Classification of Diseases, Tenth Revision codes (W32-34, X72-X74, X93-X95, and Y22-Y24). To account for seasonal variability in trauma volume, patients who presented during the first 21 months of the pandemic (April 2020-December 2021) were compared with patients treated during corresponding months of the preceding years (April 2018-December 2019). The primary outcome was monthly firearm injury rates. Demographic characteristics, intent categories, and mortality rates were compared using χ2 and Wilcoxon rank sum tests. Multivariable Poisson regression was used to assess the association between monthly firearm injuries and COVID-19 while controlling for age, sex, patient- or guardian-reported race and ethnicity based on US Census groups, insurance, zip code–based median household income, rurality, and region. Statistical analyses were performed using R, version 4.2.1 (R Foundation for Statistical Computing), and the threshold for statistical significance was a 2-sided P < .05.
Results
The analysis included 4574 children (mean [SD] age, 12.5 [4.7] years; 3595 boys [78.5%] 979 girls [21.4%]; 612 Hispanic or Latinx [13.4%], 2981 non-Hispanic Black [65.2%], and 758 non-Hispanic White [16.6%] individuals). There were 1815 firearm injuries before vs 2759 during the pandemic, a 52% increase. The monthly median (IQR) number of firearm injuries was significantly higher during (128 [118-142]) than before (86 [76-92]; P < .001) the pandemic (Table and Figure). Compared with the proportion of children with firearm injuries before the pandemic, a greater proportion of non-Hispanic Black children (62% vs 67%; P < .001), those aged 0 to 5 years (12% vs 15%; P = .03), and those with public insurance (76% vs 80%, P < .001) had firearm injuries during the pandemic. There were no significant differences between cohorts by sex, household income, rurality, region, mortality, or intent. The COVID-19 pandemic was independently associated with increased monthly firearm injuries after controlling for all covariates (incident rate ratio, 1.35; 95% CI, 1.27-1.43; P < .001)...
Language: en |