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Eze A, Leraas H, Eze O, Chime C, Grisel B, Moore L, Cerullo M, Chang D, Agarwal S, Haines KL. Factors Associated with Discharge to Skilled Nursing Facility Following Gunshot Wounds. J Surg Res 2024; 294:1-8. [PMID: 37852139 DOI: 10.1016/j.jss.2023.08.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/02/2023] [Accepted: 08/31/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Firearm injury is a public health crisis. Most victims are minorities in underserved neighborhoods. Measuring firearm injury by mortality underestimates its impact, as most victims survive to discharge. This study was done to determine if race and insurance status are associated with discharge disposition for gunshot wound (GSW)-related trauma. METHODS Using the 2019 Trauma Quality Improvement Program database, we identified GSW patients with Abbreviated Injury Scale (AIS) = 1-3. Exclusion criteria included patients who died in hospital and routine home discharge. We compared discharge patterns of patients based on demographics (age, gender, race, ethnicity, payor, AIS, hospital designation, and length of stay [LOS]) and injury severity. Multivariable logistic regression models identified factors associated with discharge disposition. RESULTS Our sample included 2437 patients with GSWs. On univariable analysis, Black patients were more likely to discharge to home with home health (64.1% Black versus 34.7% White; P < 0.001). White patients were more likely to discharge to skilled nursing facility (SNF) (51.4% White versus 44.6% Black; P < 0.001). Controlling for age, race, Latin ethnicity, primary payor, LOS, AIS severity, and injury severity score factors independently associated with discharge to SNF included age (0.0462, P < 0.001), Medicaid (1.136, P < 0.0003), Medicare (1.452, P < 0.001), and LOS (0.03745, P < 0.001). CONCLUSIONS Postacute care following traumatic injuries is essential to recovery. Black GSW victims are more likely to be discharged to home health than White patients, who are more likely to be discharged to SNF. Targeted programs to reduce barriers to appropriate aftercare are necessary to eliminate this bias and improve the care of underserved populations.
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Affiliation(s)
- Anthony Eze
- Division of Trauma Critical Care and Acute Care Surgery, Duke University Department of Surgery, Durham, North Carolina
| | - Harold Leraas
- Division of Trauma Critical Care and Acute Care Surgery, Duke University Department of Surgery, Durham, North Carolina
| | - Oluebubechukwu Eze
- Division of Trauma Critical Care and Acute Care Surgery, Duke University Department of Surgery, Durham, North Carolina
| | - Chinecherem Chime
- Division of Trauma Critical Care and Acute Care Surgery, Duke University Department of Surgery, Durham, North Carolina
| | - Braylee Grisel
- Division of Trauma Critical Care and Acute Care Surgery, Duke University Department of Surgery, Durham, North Carolina
| | - Lauren Moore
- Division of Trauma Critical Care and Acute Care Surgery, Duke University Department of Surgery, Durham, North Carolina
| | - Marcelo Cerullo
- Division of Trauma Critical Care and Acute Care Surgery, Duke University Department of Surgery, Durham, North Carolina
| | - Doreen Chang
- Division of Trauma Critical Care and Acute Care Surgery, Duke University Department of Surgery, Durham, North Carolina
| | - Suresh Agarwal
- Division of Trauma Critical Care and Acute Care Surgery, Duke University Department of Surgery, Durham, North Carolina
| | - Krista L Haines
- Division of Trauma Critical Care and Acute Care Surgery, Duke University Department of Surgery, Durham, North Carolina.
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Polcari AM, Slidell MB, Hoefer LE, Henry MC, Zakrison TL, Rogers SO, Benjamin AJ. Social Vulnerability and Firearm Violence: Geospatial Analysis of 5 US Cities. J Am Coll Surg 2023; 237:845-854. [PMID: 37966089 DOI: 10.1097/xcs.0000000000000845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Firearm violence is now endemic to certain US neighborhoods. Understanding factors that impact a neighborhood's susceptibility to firearm violence is crucial for prevention. Using a nationally standardized measure to characterize community-level firearm violence risk has not been broadly studied but could enhance prevention efforts. Thus, we sought to examine the association between firearm violence and the social, structural, and geospatial determinants of health, as defined by the Social Vulnerability Index (SVI). STUDY DESIGN In this cross-sectional study, we merged 2018 SVI data on census tract with shooting incidents between 2015 and 2021 from Baltimore, Chicago, Los Angeles, New York City, and Philadelphia. We used negative binomial regression to associate the SVI with shooting incidents per 1,000 people in a census tract. Moran's I statistics and spatial lag models were used for geospatial analysis. RESULTS We evaluated 71,296 shooting incidents across 4,415 census tracts. Fifty-five percent of shootings occurred in 9.4% of census tracts. In all cities combined, a decile rise in SVI resulted in a 37% increase in shooting incidents (p < 0.001). A similar relationship existed in each city: 30% increase in Baltimore (p < 0.001), 50% in Chicago (p < 0.001), 28% in Los Angeles (p < 0.001), 34% in New York City (p < 0.001), and 41% in Philadelphia (p < 0.001). Shootings were highly clustered within the most vulnerable neighborhoods. CONCLUSIONS In 5 major US cities, firearm violence was concentrated in neighborhoods with high social vulnerability. A tool such as the SVI could be used to inform prevention efforts by directing resources to communities most in need and identifying factors on which to focus these programs and policies.
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Affiliation(s)
- Ann M Polcari
- From the Department of Surgery, The University of Chicago Medicine, Chicago, IL (Polcari, Hoefer)
| | - Mark B Slidell
- From the Department of Surgery, The University of Chicago Medicine, Chicago, IL (Polcari, Hoefer)
| | - Lea E Hoefer
- From the Department of Surgery, The University of Chicago Medicine, Chicago, IL (Polcari, Hoefer)
| | - Marion Cw Henry
- From the Department of Surgery, The University of Chicago Medicine, Chicago, IL (Polcari, Hoefer)
| | - Tanya L Zakrison
- From the Department of Surgery, The University of Chicago Medicine, Chicago, IL (Polcari, Hoefer)
| | - Selwyn O Rogers
- From the Department of Surgery, The University of Chicago Medicine, Chicago, IL (Polcari, Hoefer)
| | - Andrew J Benjamin
- From the Department of Surgery, The University of Chicago Medicine, Chicago, IL (Polcari, Hoefer)
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Beiriger J, Silver D, Lu L, Guyette FX, Wisniewski S, Moore EE, Schreiber M, Joseph B, Wilson CT, Cotton B, Ostermayer D, Harbrecht BG, Patel M, Sperry JL, Brown JB. The Geography of Injuries in Trauma Systems: Using Home as a Proxy for Incident Location. J Surg Res 2023; 290:36-44. [PMID: 37178558 DOI: 10.1016/j.jss.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Effective trauma system organization is crucial to timely access to care and requires accurate understanding of injury and resource locations. Many systems rely on home zip codes to evaluate geographic distribution of injury; however, few studies have evaluated the reliability of home as a proxy for incident location after injury. METHODS We analyzed data from a multicenter prospective cohort collected from 2017 to 2021. Injured patients with both home and incident zip codes were included. Outcomes included discordance and differential distance between home and incident zip code. Associations of discordance with patient characteristics were determined by logistic regression. We also assessed trauma center catchment areas based on home versus incident zip codes and variation regionally at each center. RESULTS Fifty thousand one hundred seventy-five patients were included in the analysis. Home and incident zip codes were discordant in 21,635 patients (43.1%). Injuries related to motor vehicles (aOR: 4.76 [95% CI 4.50-5.04]) and younger adults 16-64 (aOR: 2.46 [95% CI 2.28-2.65]) were most likely to be discordant. Additionally, as injury severity score increased, discordance increased. Trauma center catchment area differed up to two-thirds of zip codes when using home versus incident location. Discordance rate, discordant distance, and catchment area overlap between home and incident zip codes all varied significantly by geographic region. CONCLUSIONS Home location as proxy for injury location should be used with caution and may impact trauma system planning and policy, especially in certain populations. More accurate geolocation data are warranted to further optimize trauma system design.
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Affiliation(s)
- Jamison Beiriger
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David Silver
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Liling Lu
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Francis X Guyette
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stephen Wisniewski
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ernest E Moore
- Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado Denver, Denver, Colorado
| | - Martin Schreiber
- Division of Trauma, Critical Care, & Acute Care Surgery, Oregon Health & Science University, Portland, Oregon
| | - Bellal Joseph
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Chad T Wilson
- Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Bryan Cotton
- Division of Acute Care Surgery and Center for Translational Injury Research, Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
| | - Daniel Ostermayer
- Department of Emergency Medicine, University of Texas Health Science Center, McGovern Medical School, Houston, Texas
| | - Brian G Harbrecht
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Mayur Patel
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jason L Sperry
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Joshua B Brown
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Georgeades C, Farazi M, Bergner C, Bowder A, Cassidy L, Levas MN, Nimmer M, Flynn-O'Brien KT. Characteristics and neighborhood-level opportunity of assault-injured children in Milwaukee. Inj Epidemiol 2023; 10:43. [PMID: 37605186 PMCID: PMC10441698 DOI: 10.1186/s40621-023-00453-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 07/19/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Multiple studies have explored demographic characteristics and social determinants of health in relation to the risk of pediatric assault-related injuries and reinjury. However, few have explored protective factors. The Child Opportunity Index (COI) uses neighborhood-level indicators to measure 'opportunity' based on factors such as education, social environment, and economic resources. We hypothesized that higher 'opportunity' would be associated with less risk of reinjury in assault-injured youth. METHODS This was a single-institution, retrospective study at a Level 1 Pediatric Trauma Center. Trauma registry and electronic medical record data were queried for children ≤ 18 years old with assault-related injuries from 1/1/2016 to 5/31/2021. Reinjured children, defined as any child who sustained more than one assault injury, were compared to non-reinjured children. Area Deprivation Index (ADI), a marker of socioeconomic status, and COI were determined through census block and tract data, respectively. A post-hoc analysis examined COI between all assault-injured children, unintentionally injured children, and a state-based normative cohort representative of non-injured children. RESULTS There were 55,862 traumatic injury encounters during the study period. Of those, 1224 (2.3%) assault injured children were identified, with 52 (4.2%) reinjured children and 1172 (95.8%) non-reinjured children. Reinjured children were significantly more likely to be older (median age 15.0 [IQR 13.8-17.0] vs. median age 14.0 [IQR 8.8-16.0], p < 0.001) and female (55.8% vs. 37.5%, p = 0.01) than non-reinjured children. COI was not associated with reinjury. There were also no significant differences in race, ethnicity, insurance status, ADI, or mechanism and severity of injury between cohorts. Post-hoc analysis revealed that assault-injured children were more likely to live in areas of lower COI than the other cohorts. CONCLUSIONS Compared to children who sustained only one assault during the study period, children who experienced more than one assault were more likely to be older and female. Furthermore, living in an area with more or less opportunity did not influence the risk of reinjury. However, all assault-injured children were more likely to live in areas of lower COI compared to unintentionally injured and a state-based normative cohort. Identification of factors on a social or environmental level that leads to assaultive injury warrants further exploration.
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Affiliation(s)
- Christina Georgeades
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Children's Corporate Center, Suite C320, 999 N 92nd St, Milwaukee, WI, 53226, USA.
| | - Manzur Farazi
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Children's Corporate Center, Suite C320, 999 N 92nd St, Milwaukee, WI, 53226, USA
| | - Carisa Bergner
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Children's Corporate Center, Suite C320, 999 N 92nd St, Milwaukee, WI, 53226, USA
| | - Alexis Bowder
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Children's Corporate Center, Suite C320, 999 N 92nd St, Milwaukee, WI, 53226, USA
| | - Laura Cassidy
- Department of Epidemiology and Social Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael N Levas
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mark Nimmer
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Katherine T Flynn-O'Brien
- Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Children's Corporate Center, Suite C320, 999 N 92nd St, Milwaukee, WI, 53226, USA
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Burlotos A, Pierre TJ, Johnson W, Wiafe S, Joseph M. Small area analysis methods in an area of limited mapping: exploratory geospatial analysis of firearm injuries in Port-au-Prince, Haiti. Int J Health Geogr 2023; 22:19. [PMID: 37596625 PMCID: PMC10436655 DOI: 10.1186/s12942-023-00337-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/12/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND The city of Port-au-Prince, Haiti, is experiencing an epidemic of firearm injuries which has resulted in high burdens of morbidity and mortality. Despite this, little scientific literature exists on the topic. Geospatial research could inform stakeholders and aid in the response to the current firearm injury epidemic. However, traditional small-area geospatial methods are difficult to implement in Port-au-Prince, as the area has limited mapping penetration. Objectives of this study were to evaluate the feasibility of geospatial analysis in Port-au-Prince, to seek to understand specific limitations to geospatial research in this context, and to explore the geospatial epidemiology of firearm injuries in patients presenting to the largest public hospital in Port-au-Prince. RESULTS To overcome limited mapping penetration, multiple data sources were combined. Boundaries of informally developed neighborhoods were estimated from the crowd-sourced platform OpenStreetMap using Thiessen polygons. Population counts were obtained from previously published satellite-derived estimates and aggregated to the neighborhood level. Cases of firearm injuries presenting to the largest public hospital in Port-au-Prince from November 22nd, 2019, through December 31st, 2020, were geocoded and aggregated to the neighborhood level. Cluster analysis was performed using Global Moran's I testing, local Moran's I testing, and the SaTScan software. Results demonstrated significant geospatial autocorrelation in the risk of firearm injury within the city. Cluster analysis identified areas of the city with the highest burden of firearm injuries. CONCLUSIONS By utilizing novel methodology in neighborhood estimation and combining multiple data sources, geospatial research was able to be conducted in Port-au-Prince. Geospatial clusters of firearm injuries were identified, and neighborhood level relative-risk estimates were obtained. While access to neighborhoods experiencing the largest burden of firearm injuries remains restricted, these geospatial methods could continue to inform stakeholder response to the growing burden of firearm injuries in Port-au-Prince.
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Affiliation(s)
- Athanasios Burlotos
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tayana Jean Pierre
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Universite Notre Dame D'Haiti, Faculte de Medecine, Port-au-Prince, Haïti
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Walter Johnson
- Loma Linda University School of Public Health, Loma Linda, CA, USA
| | - Seth Wiafe
- Loma Linda University School of Public Health, Loma Linda, CA, USA
| | - Michelle Joseph
- Clinical Trials Unit, University of Warwick, Coventry, CV2 2DX, United Kingdom.
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
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Lal A, John KJ, Mishra AK, Sherif AA. Burden of firearm-related injuries as associated secondary diagnosis in the United States from National Inpatient Sample Dataset. Intern Emerg Med 2023; 18:457-465. [PMID: 36592271 PMCID: PMC9806811 DOI: 10.1007/s11739-022-03190-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/24/2022] [Indexed: 01/03/2023]
Abstract
There is little known about the differences, from the point of view of healthcare resource utilization, between non-fatal versus fatal firearm-related injuries. We undertook this research project utilizing the National Inpatient Sample (NIS) database to address this critical knowledge gap. Our aims for this study were to describe the patterns of FRI in the United States during the period of 2016-2019 and to evaluate the patient-centered outcomes in the survivor (non-fatal injuries) versus the non-survivor (fatal injuries) groups. We used the National Inpatient Sample (NIS) Database, 2016-2019 (5) (~ 20% of United States hospitalizations) to identify patients with an associated diagnosis of firearm-related injuries (FRI) [Gibson T et al (2016) in Agency for Healthcare Research and Quality 2016-02]. We found that the individuals from the lowest quartile of annual household income, males, young Americans, and racial minorities were disproportionally affected The non-survivor (fatal injuries) group had a shorter length of stay in the hospital by 5.1 days (95% CI - 5.64 to - 4.58, p value = < 0.01), the higher median cost of hospitalization by $8903 (95% confidence interval $311.9 to $17,494.2, p value = 0.04), and a higher median cost of hospitalization per day by $41,576.74 (95% confidence interval $ 40,333.1 to $42,820.3, p value = < 0.01). In conclusion, the individuals from the lowest quartile of annual household income, males, young Americans and racial minorities were disproportionally affected. Firearm-related injuries pose a persistent healthcare cost burden with the cumulative and per day cost of hospitalization for fatal injuries being significantly higher than the non-fatal injuries despite a shorter hospital LOS.
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Affiliation(s)
- Amos Lal
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Kevin John John
- Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Ajay Kumar Mishra
- Department of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Akil Adrian Sherif
- Department of Cardiovascular Medicine, Saint Vincent Hospital, Worcester, MA, USA
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Comparing forms of neighborhood instability as predictors of violence in Richmond, VA. PLoS One 2022; 17:e0273718. [PMID: 36067172 PMCID: PMC9447869 DOI: 10.1371/journal.pone.0273718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/07/2022] [Indexed: 11/27/2022] Open
Abstract
Violence events tend to cluster together geospatially. Various features of communities and their residents have been highlighted as explanations for such clustering in the literature. One reliable correlate of violence is neighborhood instability. Research on neighborhood instability indicates that such instability can be measured as property tax delinquency, yet no known work has contrasted external and internal sources of instability in predicting neighborhood violence. To this end we collected data on violence events, company and personal property tax delinquency, population density, race, income, food stamps, and alcohol outlets for each of Richmond, Virginia's 148 neighborhoods. We constructed and compared ordinary least-squares (OLS) to geographically weighted regression (GWR) models before constructing a final algorithm-selected GWR model. Our results indicated that the tax delinquency of company-owned properties (e.g., rental homes, apartments) was the only variable in our model (R2 = 0.62) that was associated with violence in all but four Richmond neighborhoods. We replicated this analysis using violence data from a later point in time which yielded largely identical results. These findings indicate that external sources of neighborhood instability may be more important to predicting violence than internal sources. Our results further provide support for social disorganization theory and point to opportunities to expand this framework.
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Saunders NR, Moore Hepburn C, Huang A, de Oliveira C, Strauss R, Fiksenbaum L, Pageau P, Liu N, Gomez D, Macpherson A. Firearm injury epidemiology in children and youth in Ontario, Canada: a population-based study. BMJ Open 2021; 11:e053859. [PMID: 34794997 PMCID: PMC8603258 DOI: 10.1136/bmjopen-2021-053859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Despite firearms contributing to significant morbidity and mortality globally, firearm injury epidemiology is seldom described outside of the USA. We examined firearm injuries among youth in Canada, including weapon type, and intent. DESIGN Population-based, pooled cross-sectional study using linked health administrative and demographic databases. SETTING Ontario, Canada. PARTICIPANTS All children and youth from birth to 24 years, residing in Ontario from 1 April 2003 to 31 March 2018. EXPOSURE Firearm injury intent and weapon type using the International Classification of Disease-10 CM codes with Canadian enhancements. Secondary exposures were sociodemographics including age, sex, rurality and income. MAIN OUTCOMES Any hospital or death record of a firearm injury with counts and rates of firearm injuries described overall and stratified by weapon type and injury intent. Multivariable Poisson regression stratified by injury intent was used to calculate rate ratios of firearm injuries by weapon type. RESULTS Of 5486 children and youth with a firearm injury (annual rate: 8.8/100 000 population), 90.7% survived. Most injuries occurred in males (90.1%, 15.5/100 000 population). 62.3% (3416) of injuries were unintentional (5.5/100 000 population) of which 1.9% were deaths, whereas 26.5% (1452) were assault related (2.3/100 00 population) of which 18.7% were deaths. Self-injury accounted for 3.7% (204) of cases of which 72.0% were deaths. Across all intents, adjusted regression models showed males were at an increased risk of injury. Non-powdered firearms accounted for half (48.6%, 3.9/100 000 population) of all injuries. Compared with handguns, non-powdered firearms had a higher risk of causing unintentional injuries (adjusted rate ratio (aRR) 14.75, 95% CI 12.01 to 18.12) but not assault (aRR 0.84, 95% CI 0.70 to 1.00). CONCLUSIONS Firearm injuries are a preventable public health problem among youth in Ontario, Canada. Unintentional injuries and those caused by non-powdered firearms were most common and assault and self-injury contributed to substantial firearm-related deaths and should be a focus of prevention efforts.
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Affiliation(s)
- Natasha Ruth Saunders
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | | | | | | | | | - Lisa Fiksenbaum
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Paul Pageau
- Department of Emergency Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | | | - David Gomez
- ICES, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Alison Macpherson
- ICES, Toronto, Ontario, Canada
- School of Kinesiology and Health Science, York University Faculty of Health, Toronto, Ontario, Canada
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Vogel JA, Burnham RI, McVaney K, Havranek EP, Edwards D, Hulac S, Sasson C. The Importance of Neighborhood in 9-1-1 Ambulance Contacts: A Geospatial Analysis of Medical and Trauma Emergencies in Denver. PREHOSP EMERG CARE 2021; 26:233-245. [DOI: 10.1080/10903127.2020.1868634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Benton B, Watson D, Ablah E, Lightwine K, Lusk R, Okut H, Bui T, Haan JM. Demographics and Incident Location of Gunshot Wounds at a Single Level I Trauma Center. Kans J Med 2021; 14:31-37. [PMID: 33654540 PMCID: PMC7889073 DOI: 10.17161/kjm.vol1413772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/23/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Kansas has seen a steady increase in the rate of firearm deaths and injuries. Little is known surrounding the demographic and geospatial factors of these firearm-related traumas. The purpose of this study was to describe the overall incidence of firearm-related traumas, identify high injury locations, and examine any racial/ethnic disparities that may exist. Methods A retrospective review was conducted of all patients 14 years or older who were admitted with a gunshot wound (GSW) to a Level I trauma center between 2016 and 2017. Results Forty-nine percent of patients were Caucasian, 26.5% African American, and 19.6% Hispanic/Latino. Hispanic/Latino patients were the youngest (25.8 ± 8.8 years) and Caucasians were the oldest (34.3 ± 14.1 years, p = 0.002). Compared to Caucasian patients, African American (42.0%) and Hispanic/Latino (54.1%) patients were more likely to be admitted to the intensive care unit (ICU; p = 0.034) and experienced longer ICU lengths of stay (2.5 ± 6.3 and 2.4 ± 4.7 days, p = 0.031, respectively). African American patients (96.0%) experienced more assaults, while Caucasians were more likely to receive gunshot wounds accidentally (26.9%, p = 0.001). More African American (86.0%) and Hispanic/Latino (89.2%) patients were injured with a handgun and Caucasians sustained the highest percentage of shotgun/rifle related injuries (16.1%, p = 0.012). Most GSWs occurred in zip codes 67202, 67203, 67213, 67211, and 67214. Geographical maps indicated that GSWs occur in neighborhoods with low-income and high minority residents and in the downtown and nightclub areas of the city. Conclusions Most GSW victims were older Caucasian males. Racial differences were noted and injury locations concentrated in certain locations.
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Affiliation(s)
- Blair Benton
- Department of Surgery, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - David Watson
- Department of Surgery, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Elizabeth Ablah
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Kelly Lightwine
- Ascension Via Christi Hospital on St. Francis, Department of Trauma Services, Wichita, KS
| | - Ronda Lusk
- Ascension Via Christi Hospital on St. Francis, Department of Trauma Services, Wichita, KS
| | - Hayrettin Okut
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Thuy Bui
- University of Kansas School of Medicine-Wichita, Department of Pediatrics, Wichita, KS
| | - James M Haan
- Department of Surgery, University of Kansas School of Medicine-Wichita, Wichita, KS.,Ascension Via Christi Hospital on St. Francis, Department of Trauma Services, Wichita, KS
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Abstract
IMPORTANCE Nonfatal gunshot injuries are the most common firearm injury, but where they frequently occur remains unclear owing to data limitations. Natural language processing can be applied to medical text narratives of gunshot injury records to classify injury location and inform prevention efforts. OBJECTIVE To examine the performance of natural language processing (NLP) and machine learning models to predict nonfatal gunshot injury locations and generate new national estimates of the locations in which these injuries occur. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of data from the National Electronic Injury Surveillance System Firearm Injury Surveillance Study on nonfatal gunshot injuries that occurred in the US between January 1, 1993, and December 31, 2015. The unweighted sample included 59 025 gunshot injuries that were initially treated at emergency departments. Data were analyzed from June 1, 2019 to July 24, 2020. MAIN OUTCOMES AND MEASURES The primary outcomes were classification of injury location and subsequent estimation of nonfatal gunshot injury location. The NLP was used to generate 6 sets of predictors, and 4 machine learning models were trained to classify the missing locations: multinomial support vector machines, lasso regression, XgBoost gradient descent, and feed-forward neural networks. For each of the 6 sets of NLP predictors, 70% of records with locations were randomly sampled to form the training set and the remaining 30% of records composed the test set. The best-performing model was validated by comparing the predicted locations were with those from existing national estimates of nonfatal gunshot injuries stratified by location and intent. RESULTS The unweighted sample included 59 025 nonfatal gunshot injuries; patients with these injuries were predominantly male (n = 52 630, [89.2%]), of Black race/ethnicity (n = 29 304 [49.6%]), and young (15-24 years; n = 27 037 [45.8%]). In total, 54 089 nonfatal gunshot injuries that were weighted to approximate national estimates were included in the analysis. Existing national estimates suggest that the most prevalent nonfatal gunshot injury location is the home (n = 14 764 [23.4%]), followed by the street or highway (n = 14 402 [22.9%]), and other public places (n = 7276 [11.6%]). After implementation of NLP classification, the most frequent gunshot injury location was the street or highway (n = 27 200 [46.1%]), followed by the home (n = 23 738 [37.7%]), and other public places (n = 10 439 [15.1%]). CONCLUSIONS AND RELEVANCE The findings of this study suggest that NLP and machine learning models may be useful for classifying gunshot injury location and that most nonfatal gunshot injuries occur in the street or highway rather than in the home; these findings can inform future firearm injury prevention efforts.
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Affiliation(s)
- Susan T. Parker
- University of Michigan School of Public Health, Ann Arbor, Michigan
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12
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Moise IK. Youth and weapons: Patterns, individual and neighborhood correlates of violent crime arrests in Miami-Dade County, Florida. Health Place 2020; 65:102407. [PMID: 32862085 DOI: 10.1016/j.healthplace.2020.102407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022]
Abstract
This study uses arrest data from the Miami-Dade County Police Department (n = 13 districts) for 2014-2017 to identify census tracts in which weapon violence arrests among young people aged 10-24 is high, and models area-level predictors of the total number of violent weapons crimes by census tract (greenness and socioeconomic status indices, population density and weapon dealers), after adjusting for arrestee-level factors (age, race and gender). Combined, handguns and firearms accounted for 23.2% (n = 1330) of all arrests (including murder and non-negligent manslaughter, rape, robbery, and aggravated assault). Arrests for weapon -related violent crime are concentrated in census tracts located in the north and south neighborhoods of Miami-Dade County. Findings indicate that arrestee factors and a neighborhood greenness index are more important than population density, weapon dealers and poverty in predicting arrests for weapon-related violent crime at the census tract level.
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Affiliation(s)
- Imelda K Moise
- Department of Geography and Regional Studies, University of Miami, 1300 Campo Sano Ave, Coral Gables, FL, 33124, United States.
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13
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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.
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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.
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14
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15
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Mills B, Hajat A, Rivara F, Nurius P, Matsueda R, Rowhani-Rahbar A. Firearm assault injuries by residence and injury occurrence location. Inj Prev 2019; 25:i12-i15. [PMID: 30928914 DOI: 10.1136/injuryprev-2018-043129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/27/2019] [Accepted: 03/01/2019] [Indexed: 11/04/2022]
Abstract
Research on spatial injury patterns is limited by a lack of precise injury occurrence location data. Using linked hospital and death records, we examined residence and injury locations for firearm assaults and homicides in or among residents of King County, Washington, USA from 1 January 2010 to 31 December 2014. In total, 670 injuries were identified, 586 with geocoded residence and injury locations. Three-quarters of injuries occurred outside the census tract where the victim resided. Median distance between locations was 3.9 miles, with victims 18-34 having the greatest distances between residence and injury location. 40 of 398 tracts had a ratio of injury incidents to injured residents of >1. Routine collection of injury location data and homelessness status could decrease misclassification and bias. Researchers should consider whether residential address is an appropriate proxy for injury location, based on data quality and their specific research question.
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Affiliation(s)
- Brianna Mills
- Department of Epidemiology, University of Washington, Seattle, Washington, USA .,Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, USA
| | - Anjum Hajat
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, USA
| | - Frederick Rivara
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,Seattle Children's Hospital, Seattle, Washington, USA
| | - Paula Nurius
- Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, USA.,Department of Social Work, University of Washington, Seattle, Washington, USA
| | - Ross Matsueda
- Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, USA.,Department of Sociology, University of Washington, Seattle, Washington, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.,Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, USA
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16
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Avraham JB, Frangos SG, DiMaggio CJ. The epidemiology of firearm injuries managed in US emergency departments. Inj Epidemiol 2018; 5:38. [PMID: 30318556 PMCID: PMC6186529 DOI: 10.1186/s40621-018-0168-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/14/2018] [Indexed: 12/02/2022] Open
Abstract
Background Firearm-related injuries cause significant morbidity and mortality in the United States (US), consuming resources and fueling political and public health discourse. Most analyses of firearm injuries are based on fatality statistics. Here, we describe the epidemiology of firearm injuries presenting to US emergency departments (EDs). Methods We performed a retrospective study of the Healthcare Cost and Utilization Program Nationwide Emergency Department Survey (NEDS) from 2009 to 2012. NEDS is the largest all-payer ED survey in the US containing approximately 30 million annual records. Results include survey-adjusted counts, proportions, means, and rates, and confidence intervals of age-stratified ED discharges for firearm injuries. Results There were 71,111 (se = 613) ED discharges for firearm injuries in 2009; the absolute number increased 3.9% (se = 1.2) to 75,559 (se = 610) in 2012. 18-to-44-year-olds accounted for the largest proportion of total injuries with 52,187 (se = 527) in 2009 and 56,644 (se = 528) in 2012—a 7.2% (se = 1.6) relative rate increase and an absolute increase of 3.3/100,000 (se = 0.7). Firearm injuries among children < 5-years-old increase 16%, and 19% among children 5-to-9-years-old. 136,112 (se = 761)—or 48.2%—of those injured were treated and discharged home without admission; 106,927 (se = 755) were admitted. Firearm deaths represented one-third of all trauma mortality. Three-quarters of those injured resided in neighborhoods with median incomes below $49,250. Conclusions Firearm injuries increased from 2009 to 2012, driven by adults aged 18-to-44-years-old, and disproportionately impacting lower socioeconomic communities. Injuries also increased among young children. Firearm injuries remain a continued public health challenge, and a significant source of ED morbidity and mortality.
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Affiliation(s)
- Jacob B Avraham
- Department of Surgery, Division of Acute Care and Trauma Surgery, New York University School of Medicine, 462 First Avenue, 15NBV, New York, NY, 10016, USA
| | - Spiros G Frangos
- Department of Surgery, Division of Acute Care and Trauma Surgery, New York University School of Medicine, 462 First Avenue, 15NBV, New York, NY, 10016, USA
| | - Charles J DiMaggio
- Department of Surgery, Division of Acute Care and Trauma Surgery, New York University School of Medicine, 462 First Avenue, 15NBV, New York, NY, 10016, USA. .,Department of Population Health, New York University School of Medicine, New York, NY, USA.
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17
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Carter PM, Cunningham RM. Adequate Funding for Injury Prevention Research Is the Next Critical Step to Reduce Morbidity and Mortality From Firearm Injuries. Acad Emerg Med 2016; 23:952-5. [PMID: 27062328 PMCID: PMC7182090 DOI: 10.1111/acem.12982] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Patrick M Carter
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI
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