2
|
Gomez D, Saunders N, Greene B, Santiago R, Ahmed N, Baxter NN. Firearm-related injuries and deaths in Ontario, Canada, 2002-2016: a population-based study. CMAJ 2021; 192:E1253-E1263. [PMID: 33077520 DOI: 10.1503/cmaj.200722] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Firearm-related injury is an important and preventable cause of death and disability. We describe the burden, baseline characteristics and regional rates of firearm-related injury and death in Ontario. METHODS We conducted a population-based cross-sectional study using linked data from health administrative data sets held at ICES. We identified residents of Ontario of all ages who were injured or died as a result of a firearm discharge between Apr. 1, 2002, and Dec. 31, 2016. We included injuries classified as assault, unintentional, self-harm or undetermined intent secondary to handguns, rifles, shotguns and larger firearms. The primary outcome was the incidence of nonfatal and fatal injuries resulting in an emergency department visit, hospital admission or death. We also describe regional and temporal rates. RESULTS We identified 6483 firearm-related injuries (annualized injury rate 3.54 per 100 000 population), of which 2723 (42.3%) were fatal. Assault accounted for 40.2% (1494/3715) of nonfatal injuries and 25.5% (694/2723) of deaths. Young men, predominantly in urban neighbourhoods, within the lowest income quintile were overrepresented in this group. Injuries secondary to self-harm accounted for 68.0% (1366/2009) of injuries and occurred predominantly in older men living in rural Ontario across all income quintiles. The case fatality rate of injuries secondary to self-harm was 91.7%. Self-harm accounted for 1842 deaths (67.6%). INTERPRETATION We found that young urban men were most likely to be injured in firearm-related assaults and that more than two-thirds of self-harm-related injuries occurred in older rural-dwelling men, most of whom died from their injuries. This highlights a need for suicide-prevention strategies in rural areas targeted at men aged 45 or older.
Collapse
Affiliation(s)
- David Gomez
- Division of General Surgery (Gomez, Greene, Ahmed), Department of Surgery, University of Toronto; Division of General Surgery (Gomez, Ahmed), St. Michael's Hospital, Unity Health Toronto; Li Ka Shing Knowledge Institute (Gomez, Ahmed, Baxter), St. Michael's Hospital, Unity Health Toronto; ICES (Gomez, Saunders, Santiago, Baxter); Division of Pediatric Medicine (Saunders), The Hospital for Sick Children; Department of Pediatrics (Saunders), University of Toronto; Institute of Health Policy, Management and Evaluation (Saunders, Baxter), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
| | - Natasha Saunders
- Division of General Surgery (Gomez, Greene, Ahmed), Department of Surgery, University of Toronto; Division of General Surgery (Gomez, Ahmed), St. Michael's Hospital, Unity Health Toronto; Li Ka Shing Knowledge Institute (Gomez, Ahmed, Baxter), St. Michael's Hospital, Unity Health Toronto; ICES (Gomez, Saunders, Santiago, Baxter); Division of Pediatric Medicine (Saunders), The Hospital for Sick Children; Department of Pediatrics (Saunders), University of Toronto; Institute of Health Policy, Management and Evaluation (Saunders, Baxter), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
| | - Brittany Greene
- Division of General Surgery (Gomez, Greene, Ahmed), Department of Surgery, University of Toronto; Division of General Surgery (Gomez, Ahmed), St. Michael's Hospital, Unity Health Toronto; Li Ka Shing Knowledge Institute (Gomez, Ahmed, Baxter), St. Michael's Hospital, Unity Health Toronto; ICES (Gomez, Saunders, Santiago, Baxter); Division of Pediatric Medicine (Saunders), The Hospital for Sick Children; Department of Pediatrics (Saunders), University of Toronto; Institute of Health Policy, Management and Evaluation (Saunders, Baxter), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
| | - Robin Santiago
- Division of General Surgery (Gomez, Greene, Ahmed), Department of Surgery, University of Toronto; Division of General Surgery (Gomez, Ahmed), St. Michael's Hospital, Unity Health Toronto; Li Ka Shing Knowledge Institute (Gomez, Ahmed, Baxter), St. Michael's Hospital, Unity Health Toronto; ICES (Gomez, Saunders, Santiago, Baxter); Division of Pediatric Medicine (Saunders), The Hospital for Sick Children; Department of Pediatrics (Saunders), University of Toronto; Institute of Health Policy, Management and Evaluation (Saunders, Baxter), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
| | - Najma Ahmed
- Division of General Surgery (Gomez, Greene, Ahmed), Department of Surgery, University of Toronto; Division of General Surgery (Gomez, Ahmed), St. Michael's Hospital, Unity Health Toronto; Li Ka Shing Knowledge Institute (Gomez, Ahmed, Baxter), St. Michael's Hospital, Unity Health Toronto; ICES (Gomez, Saunders, Santiago, Baxter); Division of Pediatric Medicine (Saunders), The Hospital for Sick Children; Department of Pediatrics (Saunders), University of Toronto; Institute of Health Policy, Management and Evaluation (Saunders, Baxter), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
| | - Nancy N Baxter
- Division of General Surgery (Gomez, Greene, Ahmed), Department of Surgery, University of Toronto; Division of General Surgery (Gomez, Ahmed), St. Michael's Hospital, Unity Health Toronto; Li Ka Shing Knowledge Institute (Gomez, Ahmed, Baxter), St. Michael's Hospital, Unity Health Toronto; ICES (Gomez, Saunders, Santiago, Baxter); Division of Pediatric Medicine (Saunders), The Hospital for Sick Children; Department of Pediatrics (Saunders), University of Toronto; Institute of Health Policy, Management and Evaluation (Saunders, Baxter), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
| |
Collapse
|
3
|
Abstract
BACKGROUND Gun injury accounts for substantial acute mortality worldwide and many others survive with lingering disabilities. We investigated whether additional health losses beyond mortality can also arise for patients who survive with long-term disability. METHODS We conducted a population-based individual patient analysis of adults injured by firearms who had received emergency medical care in Ontario, Canada, from Apr. 1, 2002, to Apr. 1, 2019. Longitudinal cohort analyses were evaluated through deterministic linkages of individual electronic patient files. The primary outcome was death or subsequent application for long-term disability in the years after hospital discharge. RESULTS In total, 8313 patients were injured from firearms, of which 3020 were injured from intentional incidents and 5293 were injured from unintentional incidents. A total of 2657 (88.0%) patients with intentional gun injury and 5089 (96.1%) patients with unintentional gun injury survived initial injuries. After a mean 7.75 years of follow-up, patients surviving intentional injuries had a disability rate twice as high as patients surviving unintentional injuries (19.7% v. 10.1%, p < 0.001), equivalent to a hazard ratio of 2.01 (95% confidence interval 1.80-2.25). The higher risk of long-term disability for survivors after intentional gun injury was not explained by demographic characteristics, extended to survivors treated and released from the emergency department, and was observed regardless of whether the incident was self-inflicted or from interpersonal assault. Half of the disability cases were identified after the first year. Additional predictors of long-term disability included a lower socioeconomic status, an urban home location, arrival by ambulance transport, a history of mental illness and a diagnosis of substance use disorder. INTERPRETATION Our study shows that gun death statistics underestimate the extent of health losses from long-term disability, particularly for those with intentional injuries. Additional and sustainable follow-up medical care might improve patient outcomes.
Collapse
Affiliation(s)
- Sheharyar Raza
- Department of Medicine (Raza, Redelmeier), University of Toronto; Evaluative Clinical Sciences (Raza, Thiruchelvam, Redelmeier), Sunnybrook Research Institute; ICES in Ontario (Thiruchelvam); Institute of Health Policy, Management and Evaluation (Redelmeier), Toronto, Ont
| | - Deva Thiruchelvam
- Department of Medicine (Raza, Redelmeier), University of Toronto; Evaluative Clinical Sciences (Raza, Thiruchelvam, Redelmeier), Sunnybrook Research Institute; ICES in Ontario (Thiruchelvam); Institute of Health Policy, Management and Evaluation (Redelmeier), Toronto, Ont
| | - Donald A Redelmeier
- Department of Medicine (Raza, Redelmeier), University of Toronto; Evaluative Clinical Sciences (Raza, Thiruchelvam, Redelmeier), Sunnybrook Research Institute; ICES in Ontario (Thiruchelvam); Institute of Health Policy, Management and Evaluation (Redelmeier), Toronto, Ont.
| |
Collapse
|