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US regions with stricter gun laws have lower rates of pediatric injuries due to firearms

September 15, 2017

CHICAGO - New research shows regions of the United States that have the strictest gun laws also have the lowest rates of childhood firearm injuries, with the Northeast region of the U.S. having the lowest rates of child injuries due to guns.

The study abstract, "Geographic Regions with Stricter Gun Laws Have Fewer Emergency Department Visits for Pediatric Firearm-Related Injuries: A Five-Year National Study," will be presented Friday, Sept. 15, at the American Academy of Pediatrics National Conference & Exhibition in Chicago.

For the study, researchers compared regional firearms laws to the number of firearms-related injuries in regional emergency departments. Using national data from the Nationwide Emergency Department Sample from 2009-2013, researchers analyzed 111,839 emergency department visits for pediatric firearm-related injuries across the U.S., broken down by state and region.

"Our research confirms that regions that have stricter gun laws have a significantly lower rate of firearm injuries among children," said Monika Goyal, MD, MSCE, an assistant professor of pediatrics and emergency medicine at Children's National Health System and The George Washington University.

For their analysis, researchers ranked each region in the U.S. using the Brady Gun Law Score, which scores all 50 states based on policy approaches to regulating guns and ammunition, such as background checks on gun sales, reporting lost or stolen firearms, and restricting the purchase of weapons among high-risk populations. A higher regional median Brady Gun Law Score indicates stricter gun laws. The Northeast region of the U.S. received the highest score at 45, with the Midwest and Western regions next at 9, while the South received the lowest score at 8.

Researchers then compared the regions' Brady Gun Law Score to the number of pediatric emergency department visits for firearm injury. They found that the regions with higher Brady scores also had lower rates of emergency department visits for firearm injuries among children and teens, suggesting that stricter gun laws are correlated with lower firearm injury rates among youths.

Researchers found that firearm injury rates in the Northeast decreased during the study period and that the Northeast had the lowest rate: 40 firearm injuries to children and teens per 100,000 emergency department visits. This was followed by the Midwest, with a rate of 62 injuries to children and teens per 100,000 visits, and the West at 68 injuries to children and teens per 100,000 visits. The South at 71 injuries per 100,000 visits had the highest rates of visits for pediatric firearm injuries.

During the study period, firearm-related emergency department visits remained consistent at a rate of 65 injuries to children and teens per 100,000 pediatric visits or 22,368 visits per year, on average. Of those injuries, the average age of emergency department patients seen for firearm injuries was 18 years of age, and most of those seen were male. Researchers found that during the study timeframe, 6,500 patients died and more than one-third of these children and teens were admitted to the hospital for their injuries.

"Our study highlights the regional variations in gun laws," says Dr. Goyal. "It also suggests how gun laws may help to reduce the number of pediatric firearm victims being treated in the emergency department each year."
-end-
The abstract, available below, will be presented by Shilpa Patel, M.D., M.P.H., an assistant professor of pediatrics and emergency medicine at Children's National Health System and The George Washington University - whom Dr. Goyal mentors - on Friday, Sept.15, from 3:00 p.m. to 3:15 p.m. CT in McCormick Place West, Room S101.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.

The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org.

Abstract Title: Geographic Regions with Stricter Gun Laws Have Fewer Emergency Department Visits for Pediatric Firearm-Related Injuries: A Five-Year National Study

Purpose: Firearm-related injuries are a leading cause of morbidity and mortality among children and adolescents. States with more restrictive gun laws have fewer firearm-related pediatric fatalities. Our objective was to investigate the association between regional firearm legislation and pediatric firearm-related injuries presenting to the emergency department (ED). Methods: Repeated cross-sectional analysis using the Nationwide Emergency Department Sample (NEDS) from 2009-2013. National estimates of rates of firearm-related visits in children ? 21 years were calculated using annual census data to evaluate trends over time and by geographic region (Northeast, South, West and Midwest). State-level Brady Gun Law Scores were used to calculate median regional scores and measure the association between median regional gun law scores and firearm-related ED visits through multivariable linear regression. Results: During the 5-year study period, there were 111,839 [95% CI: 101,248,122,431] ED visits for pediatric firearm-related injuries nationwide (22,368 per year). The mean age was 18.0 years (SD 17.9-18.0), majority were male (89.3%), and publicly insured (38.5%); 6.1% (6,866) resulted in death, and 30% (33,280) resulted in hospital admission. Overall, firearm-related ED visits remained consistent over time, at a rate of 65 per 100,000 pediatric ED visits, until 2013, when there was a slight decrease to 51 per 100,000 (p-trend = 0.048). Rates of firearm-related pediatric ED visits varied by geographic region (Figure 1). Rates in the Northeast decreased during the study period (p-trend?.0001). The Northeast had the lowest rate, representing 40 (95% CI 34, 45) per 100,000 ED visits. This was followed by the Midwest, with a rate of 62 (95% CI 26, 66) per 100,000. The West (68; 95% CI 61, 74) and the South (71; 95% CI 64, 77) had the highest rates of ED visits for pediatric firearm injuries per 100,000 visits. In comparison to the Northeast, odds of firearm related-ED visits were higher in the South (aOR 1.8; 95% CI 1.4, 2.3) and the West (aOR 1.7; 95% CI 1.3, 2.2). There were no observed differences over time in mortality rates, overall or by region. A higher regional median Brady Gun Law Score (Northeast-45, South-8, West-9, Midwest-9), indicating stricter gun laws, was associated with a lower rate of firearm-related ED visits (p=0.03; Figure 2). Conclusions: Regional differences exist in pediatric firearm related injuries. Furthermore, regional differences in ED visit rates are associated with gun law scores. Regions with higher scores, and thus stricter gun laws, had fewer ED visits for pediatric firearm-related injuries than those with lower scores, and therefore, weaker laws. Studying the role of regional gun culture and its impact on firearm legislation at the regional level is an important next step in advocating for changes to firearm legislation and reducing pediatric firearm-related injuries.

American Academy of Pediatrics

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