Costs of Fatal and Nonfatal Firearm Injuries in the U.S., 2019 and 2020.

INTRODUCTION: Firearm-related injuries are among the five leading causes of death for people aged 1-44 years in the U.S. The immediate and long-term harms of firearm injuries pose an economic burden on society. Fatal and nonfatal firearm injury costs in the U.S. were estimated providing up-to-date economic burden estimates. METHODS: Counts of nonfatal firearm injuries were obtained from the 2019-2020 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample. Data on nonfatal injury intent were obtained from the National Electronic Injury Surveillance System - Firearm Injury Surveillance System. Counts of deaths (firearm as underlying cause) were obtained from the 2019-2020 multiple cause-of-death mortality data from the National Vital Statistics System. Analyses were conducted in 2023. RESULTS: The total cost of firearm related injuries and deaths in the U.S. for 2020 was $493.2 billion, a 16 percent increase compared with 2019. There are significant disparities in the cost of firearm deaths in 2019-2020, with non-Hispanic Black people, males, and young and middle-aged groups being the most affected. CONCLUSIONS: Most of the nonfatal firearm injury-related costs are attributed to hospitalization. These findings highlight the racial/ethnic differences in fatal firearm injuries and the disproportionate cost burden to urban areas. Addressing this important public health problem can help ameliorate the costs to our society from the rising rates of firearm injuries.

Association of Recent Violence Encounters With Suicidal Ideation Among Adolescents With Depression.

Importance: Suicide prevention is an important component of depression management. Knowledge about depressed adolescents with increased risk for suicide can inform suicide prevention efforts. Objective: To describe the risk of documented suicidal ideation within a year following a diagnosis of depression and to examine how the risk of documented suicidal ideation differed by recent violence encounter status among adolescents with new depression diagnoses. Design, Setting, and Participants: Retrospective cohort study in clinical settings including outpatient facilities, emergency departments, and hospitals. Using IBM's Explorys database containing electronic health records from 26 US health care networks, this study observed a cohort of adolescents with new depression diagnoses from 2017 to 2018 for up to 1 year. Data were analyzed from July 2020 to July 2021. Exposures: Recent violence encounter was defined by a diagnosis of child maltreatment (physical, sexual, or psychological abuse or neglect) or physical assault within 1 year before depression diagnosis. Main Outcomes and Measures: The main outcome was diagnosis of suicidal ideation within 1 year following depression diagnosis. Multivariable adjusted risk ratios of suicidal ideation were calculated for overall recent violence encounters and for individual forms of violence. Results: Among a total of 24 047 adolescents with depression, 16 106 (67.0%) were female and 13 437 (55.9%) were White. A total of 378 had experienceda violence (hereafter, encounter group) and 23 669 had not (hereafter, nonencounter group). Following the diagnosis of depression, 104 adolescents with any past-year violence encounter (27.5%) documented suicidal ideation within 1 year. In contrast, 3185 adolescents in the nonencounter group (13.5%) experienced thoughts of suicide following the diagnosis of depression. In multivariable analyses, those with any violence encounter had 1.7 times (95% CI 1.4-2.0) higher risk of documented suicidal ideation compared with those in the nonencounter group (P < .001). Among different forms of violence, sexual abuse (risk ratio, 2.1; 95% CI, 1.6-2.8) and physical assault (risk ratio, 1.7; 95% CI, 1.3-2.2) were associated with significantly increased risk of suicidal ideation. Conclusions and Relevance: Among adolescents with depression, persons who experienced past-year violence encounters showed a higher rate of suicidal ideation than those who had not. These findings highlight the importance of identifying and accounting for past violence encounters when treating adolescents with depression to reduce risk of suicide. Public health approaches to prevent violence may help to avert morbidity associated with depression and suicidal ideation.

Building Infrastructure for Surveillance of Adverse and Positive Childhood Experiences: Integrated, Multimethod Approaches to Generate Data for Prevention Action.

Adverse and positive childhood experiences have a profound impact on lifespan health and well-being. However, their incorporation into ongoing population-based surveillance systems has been limited. This paper outlines critical steps in building a comprehensive approach to adverse and positive childhood experiences surveillance, provides examples from the Preventing Adverse Childhood Experiences: Data to Action cooperative agreement, and describes improvements needed to optimize surveillance data for action. Components of a comprehensive approach to adverse and positive childhood experiences surveillance include revisiting definitions and measurement, including generating and using uniform definitions for adverse and positive childhood experiences across data collection efforts; conducting youth-based surveillance of adverse and positive childhood experiences; using innovative methods to gather and analyze near real-time data; leveraging available data, including from administrative sources; and integrating data on community- and societal-level risk and protective factors for adverse childhood experiences, including social and health inequities such as racism and poverty, as well as policies and conditions that create healthy environments for children and families. Comprehensive surveillance data on adverse and positive childhood experiences can inform data-driven prevention and intervention efforts, including focusing prevention programming and services to populations in greatest need. Data can be used to evaluate progress in reducing the occurrence of adverse childhood experiences and bolstering the occurrence of positive childhood experiences. Through expansion and improvement in adverse and positive childhood experiences surveillance-including at federal, state, territorial, tribal, and local levels-data-driven action can reduce children's exposure to violence and other adversities and improve lifelong health and well-being.

Association between community socioeconomic position and HIV diagnosis rate among adults and adolescents in the United States, 2005 to 2009.

OBJECTIVES: We examined the association between socioeconomic position (SEP) and HIV diagnosis rates in the United States and whether racial/ethnic disparities in diagnosis rates persist after control for SEP. METHODS: We used cases of HIV infection among persons aged 13 years and older, diagnosed 2005 through 2009 in 37 states and reported to national HIV surveillance through June 2010, and US Census data, to examine associations between county-level SEP measures and 5-year average annual HIV diagnosis rates overall and among race/ethnicity-sex groups. RESULTS: The HIV diagnosis rate was significantly higher for individuals in the low-SEP tertile than for those in the high-SEP tertile (rate ratios for low- vs high-SEP tertiles range = 1.68-3.38) except for White males and Hispanic females. The SEP disparities were larger for minorities than for Whites. Racial disparities persisted after we controlled for SEP, urbanicity, and percentage of population aged 20 to 50 years, and were high in the low-SEP tertile for males and in low- and high-SEP tertiles for females. CONCLUSIONS: Findings support continued prioritization of HIV testing, prevention, and treatment to persons in economically deprived areas, and Blacks of all SEP levels.

Improving ascertainment of risk factors for HIV infection: results of a group-randomized evaluation.

To allow appropriate allocation of prevention and care funding, HIV/AIDS surveillance data must include risk factor information, currently available for less than 70% of cases reported in the United States. The authors evaluated an intervention consisting of provider training and materials to improve risk factor reporting. Facilities were matched prior to randomization to intervention or control, and generalized linear mixed models were used to test for an intervention effect. Twenty-one percent of cases from intervention facilities and 33.4% from control facilities (p = .09) were reported without any risk factor information. The pre-post difference (20.7% for intervention and 36.0% for control) was not significant among HIV cases (p = .11) nor among AIDS cases (p = .12; 21.3% for intervention and 31.1% for control). The methods the authors' evaluated may need to be combined with other approaches and/or alternative classification schemes to significantly reduce the percentage of cases reported to surveillance without risk factor information.

County-level socioeconomic status and survival after HIV diagnosis, United States.

PURPOSE: To estimate relative survival (RS) after human immunodeficiency virus (HIV) diagnosis, by race/ethnicity and county-level socioeconomic status (SES). METHODS: We estimated 5-year RS by age, race/ethnicity, transmission category, sex, diagnosis year, CD4 count, and by county-level SES variables from the U.S. Census. Data, from the national HIV/AIDS Reporting System, were for HIV-infected persons ages > or =13 years (diagnosis during 1996-2003 and follow-up through 2005). We calculated RS proportions by using a maximum likelihood algorithm and modeled the relative risk of excess death (RR) using generalized linear models, with poverty as a random effect. RESULTS: For men, RS was worse in counties with larger proportions of people living below the 2000 U.S. poverty level (87.7% for poverty of > or =20% vs. 90.1% for poverty of <5.0%) and where unemployment was greater (87.8% where unemployment > 7.1% vs. 90.5% where unemployment < 4.0%). The effects of county-level SES on RS of women were similar. In multilevel multivariate models, RR for men and women within 5 years after an HIV diagnosis was significantly worse in counties where 10.0-19.9% (compared with <5.0%) lived below the poverty level (RR = 1.3 [95% CI 1.2-1.5] and RR = 1.8 [95% CI 1.4-2.2], respectively). CONCLUSIONS: RS was worse in lower SES areas. To help address the impact of county-level SES, resources for HIV testing, care, and proven economic interventions should be directed to areas with concentrations of economically disadvantaged people.