ABSTRACT
Understanding the life years lost by assault and suicide due to firearms among white and black Americans can help us understand the race-specific and intent-specific firearm mortality burden and inform prevention programmes. The objective was to assess national and race-specific life expectancy loss related to firearms in the USA due to assault and suicide. We used firearm mortality data available from Wide-ranging Online Data for Epidemiologic Research to calculate the life expectancy loss between 2000 and 2016 separately for assaults and suicides among white and black Americans. The total national life expectancy loss due to firearms was 2.48 (2.23 whites, 4.14 blacks) years. The total life expectancy loss in years due to firearm assault was 0.95 (0.51 whites, 3.41 blacks) and suicide was 1.43 (1.62 whites, 0.60 blacks), respectively. Firearm life expectancy loss in years at birth, 20, 40 and 60 years of age was 0.29 (0.22 whites, 0.56 blacks), 0.25 (0.21 whites, 0.47 blacks), 0.09 (0.10 whites, 0.08 blacks) and 0.03 (0.03 whites, 0.01 blacks) years. National firearm life expectancy loss in days from 20 to 60 years declined by 79.5 (65.8 whites, 166.3 blacks); for assault by 37.5 (18.9 whites, 141.0 blacks) and suicides by 38.7 (43.9 whites, 20.3 blacks). Americans lose substantial years of life due to firearm injury. This loss in life years is characterised by a large racial gap by age and intent. Tailored prevention programmes are needed to reduce this loss and lessen the racial gaps.
Subject(s)
Black or African American/statistics & numerical data , Life Expectancy , White People/statistics & numerical data , Wounds, Gunshot/mortality , Adult , Age Factors , Aged , Cross-Sectional Studies , Female , Firearms , Humans , Male , Middle Aged , United States/epidemiology , Wounds, Gunshot/ethnology , Young AdultABSTRACT
The majority of the burden of firearm injury in the United States is on men as compared to women. There is limited evidence regarding sex differences in short-term hospitalization outcomes after surviving firearm injury. The risk of cardiovascular and all-cause hospital readmission, length of stay (LOS), and costs within 180 days after surviving an index firearm injury was compared between males and females. A claims-based, retrospective, cohort study was performed using Nationwide Readmission Database (2013-2014) to obtain a cohort of patients who survived an index hospitalization of firearm injury. The analysis was performed in August 2017. Cox proportional hazard regression models were used to estimate hazard ratio (HR) and 95% confidence intervals (95% CIs). Among 17,594 males and 2,289 females discharged alive after index firearm injury hospitalization, 14.4% and 13.2% were readmitted within 180 days. Within 180 days, the risk of cardiovascular readmission was 3.3 times greater among males versus females (HR = 3.34, 95% CI [1.18, 9.44]. Risk of all-cause readmission among males was greater at 90 days (HR = 1.40, 95% CI [1.04, 1.87]. Patients surviving a firearm injury have a substantial risk of subsequent hospitalizations. Cardiovascular readmissions are greater among males than females during the first 6 months after injury and may be indicative of a continuing long-term risk of health and patient outcomes that contributes to the overall burden of firearm injury.
Subject(s)
Cardiovascular Diseases/epidemiology , Health Care Costs , Hospitalization/statistics & numerical data , Patient Readmission/statistics & numerical data , Wounds, Gunshot/epidemiology , Wounds, Gunshot/therapy , Acute Kidney Injury/diagnosis , Acute Kidney Injury/epidemiology , Acute Kidney Injury/therapy , Adolescent , Adult , Age Distribution , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/therapy , Cohort Studies , Databases, Factual , Female , Firearms/statistics & numerical data , Hospitalization/economics , Humans , Incidence , Injury Severity Score , Kaplan-Meier Estimate , Length of Stay/economics , Male , Middle Aged , Patient Readmission/economics , Proportional Hazards Models , Retrospective Studies , Sex Distribution , Survivors , United States , Wounds, Gunshot/diagnosis , Young AdultABSTRACT
PURPOSE: To better understand the effects of race and/or ethnicity and neighborhood poverty on pediatric firearm injuries in the United States, we compared overall and intent-specific firearm hospitalizations (FH) with those of pedestrian motor vehicle crash hospitalizations (PMVH). METHODS: We used Nationwide Inpatient Sample data (1998-2011) among 0-15 year-olds in a 1:1 case-case study; 4725 FH and 4725 PMVH matched by age, year, and region. RESULTS: Risk of FH versus PMVH was 64% higher among black children, Odds ratio (OR) = 1.64, 95% confidence interval (95% CI) = 1.44-1.87, as compared to white children (P < .0001); this risk did not vary by neighborhood poverty (P interaction = .52). Risk of homicide FH versus PMVH was 842% higher among black (OR = 8.42, 95% CI = 6.27-11.3), 452% higher among Hispanics (OR = 4.52, 95% CI = 3.33-6.13) and 233% higher among other race (OR = 2.33, 95% CI = 1.52-3.59) compared to white children. There was a lower risk for unintentional FH among black OR = 0.73, 95% CI = 0.62-0.87, Hispanics (OR = 0.60, 95% CI = 0.49-0.74), and other (OR = 0.63, 95% CI = 0.47-0.83) compared to whites. These intent-specific risks attributed to race did not vary by neighborhood affluence. CONCLUSIONS: Black children were at greater likelihood of FH compared to white children regardless of neighborhood economic status. Minority children had an increased likelihood of intentional FH and a decreased likelihood of unintentional FH as compared to white children irrespective of neighborhood income.
