Older urban teens most likely to be hospitalized for firearm injury, study finds

The hospitalization rate is higher in urban areas than rural areas overall, but but for 5- to 14-year-olds hospitalizations are lower in urban areas than rural areas, the researchers found. Injuries in both age groups are typically unintentional.

"Male sex, non-white race and late adolescent age are risk factors for pediatric and adolescent firearm injuries," said Dr. James Dodington, an assistant professor of pediatrics at the Yale School of Medicine and an author of the report, published Monday in the journal Pediatrics. "But what has not been clearly defined is, what are the rates of firearm injury hospitalizations between rural and urban populations?"

The fact that the 5- to 14-year-olds in rural areas had a higher rate of hospitalization was something that has not been clearly reported elsewhere, Dodington said.

He noted that the study displays what is occurring but not necessarily why. "And we think it requires some further investigation, as that population doesn't take up the large media landscape around firearm injuries being very common around urban adolescents."

Researchers used data from the nationally representative Kids' Inpatient Database, which was created by the federal Agency for Healthcare Research and Quality and collects data on children's hospitalizations, from 2006, 2009 and 2012. They compared hospitalizations by demographics and by intent, classified in this report as assault, self-inflicted, unintentional or undetermined. Within that period, there were 21,581 hospitalizations due to firearm injuries.

The researchers defined urban areas as metropolitan counties with populations greater than 50,000; micropolitan areas were between 10,000 and 49,999 people; and rural areas were nonmetropolitan, nonmicropolitan counties with a population of fewer than 10,000 people.

An important limitation of the study was that it looked only at patients with firearm injuries that resulted in hospitalizations, so it did not include those who died before reaching a hospital, said Dr. Megan Ranney, an associate professor of emergency medicine at Brown University who was not involved with the research.

"Those kids by and large are not going to make it to the doors of the ER," said Ranney, who is also the chief research officer for the American Foundation for Firearm Injury Reduction in Medicine.

Irrespective of location, 6% of all children with firearm injuries died while they were hospitalized, the study states.

The report also supported previously published research that found deaths resulting from firearm homicide occur more frequently in urban counties while suicide and unintentional firearm deaths are more prevalent in rural counties. In particular, 15- to 19-year-olds in rural areas had the highest rate of hospitalization for self-inflicted injury.

"Firearm injury is not a monolith. Just like with any other public health problem, we need to do good high-quality research to identify ways to reduce harm for different populations," Ranney said. "So we probably need strategies that are a little different for kids living in rural Wyoming versus kids living in inner-city Flint, Michigan."

To lower these incidences of firearm injury, the report calls for individual and community-focused awareness and education campaigns, safety and injury prevention, mental health access and screening, as well as violence prevention programs.

"We've reduced car crash deaths, we've reduced smoking, we've reduced the number of deaths from HIV by using a good strong public health approach, and I'm confident we can do the same thing for gun violence," Ranney said. "This paper highlights the very human toll of the epidemic across the country, but talking about it being a problem is not enough. We have to do something."