Almost 7,400 children and adolescents were hospitalized for firearm-related injuries in 2009, and more than half were due to assaults, in what the authors say is the first study to highlight "the substantial morbidity" experienced by children and adolescents in the United States who survive a firearm injury and are hospitalized.
The rates of hospitalizations were highest in teenagers aged 15-19 years and among black males, reported Dr. John M. Leventhal, of the pediatrics department at Yale University, New Haven, Conn., and his associates. In 6% of the cases, the child or adolescent died while hospitalized. For black males aged 15-19 years, the estimated annual risk of hospitalization for a firearm injury was 1 per 672.
"Public health efforts should be dedicated to reducing this common source of childhood injuries," the authors concluded, noting that the results "underscore the important role that pediatricians and other health care providers who care for children can play in the primary prevention of firearm injuries." The study appeared in the February 2014 issue of Pediatrics (2014;133:219-25).
Using data from the 2009 Kids’ Inpatient Database, a nationally representative sample of discharge data from more than 4,000 acute care hospitals in 44 states, representing 96% of the U.S. population, they calculated hospitalizations for nonfatal injuries caused by firearms in children and adolescents under age 20, which included injuries due to BB and air guns but not paintball guns.
There were 7,391 such hospitalizations. Most – almost 62% – of the injuries were related to assaults, and the least amount – almost 4% – were due to suicide attempts. The injuries were categorized as unintentional in two-thirds of children under age 10, 54% in those aged 10-14 years, and 24% among those aged 15-19 years.
Almost 90% of the hospitalizations were in males; and the gender difference was present, no matter the cause of the injury.
The authors also identified significant racial differences: 47% of the hospitalizations were in black children and adolescents vs. 16% in whites and 19% in Hispanics; 54% of the hospitalizations due to assaults were in black children and adolescents vs. almost 9% in whites and 21% in Hispanics (the rest were in unknown or other categories of race or ethnicity). Almost 14% of the suicide attempts were in black children, compared with 50% in white children and adolescents, a significant difference (14% of the suicide attempts were in Hispanics).
Compared with those aged 4 years and younger, those in the 15- to 19-year age group were about 121 times more likely to be hospitalized for a firearms-related assault and almost 146 times more likely to be hospitalized for an unintentional injury.
The overall hospitalization rate due to firearm injuries was 8.87 per 100,000 persons under age 20, with markedly higher rates among those aged 15-19 years. When the investigators calculated rates based on race and gender, they found the highest rates among black children and adolescents – about 25 per 100,000 persons – compared with 7.93 among Hispanics, 6.56 for other races, and 2.6 among whites.
The rate among males was about 15 per 100,000 persons, compared with almost 2 per 100,000 persons for females. The rate for black males was almost 45 per 100,000 persons, compared with about 4 per 100,000 persons among white males. And among those aged 15-19 years, the rate among black males was almost 149 per 100,000 persons, vs. about 11 per 100,000 persons for white males in this age group. There were similar differences among females, but the differences "were not as dramatic," the authors said.
The most common injuries were open wounds, in about half of the cases, and fractures in about half of cases, and internal injuries of the thorax, abdomen, or pelvis in about 34%. Almost 62% of the those hospitalized had a major procedure in the operating room. Almost half the hospitalizations were covered by Medicaid, followed by private health insurance in 25%, almost 17% self-pay (uninsured), and 8.5% by other types of health insurance – with a similar distribution of payment type for undetermined and unintentional assaults. However, almost half of the hospitalizations for suicide attempts were paid by private insurance, while only about 25% were covered by Medicaid.
The authors had no relevant financial disclosures or potential conflicts of interest.