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American Journal of Public Health, Volume 115, Issue 4, Page 596-604, April 2025.

Mechanisms of pediatric injury: an 11-yr review of injury trends

Background/purpose

Unintentional injuries are the leading cause of death among children and adolescents. The objective of this study was to describe temporal trends of paediatric traumatic injury over an 11-year period by mechanism of injury (MOI), age, sex, race and ethnicity, injury severity and hospital discharge disposition.

Methods

The National Trauma Data Bank was queried to identify paediatric patients (1–17 years old) injured from 2012 to 2022. Two-sided non-parametric Mann-Kendall trend tests were used to evaluate temporal trends of MOI for all patients and within demographic groups.

Results/outcomes

Over the 11-year period, 1 092 308 injury records met study inclusion criteria and had complete demographic and MOI data. Across all patients, there was a significant increase in bites and stings, cut/pierce injuries and firearm injuries, whereas there were decreasing trends in pedestrian and other blunt injuries over time. There was a significant increase in injury over time for Black, Hispanic or Latino, and Pacific Islander patients and those 5–9 years old. The MOIs with the highest injury severity and in-hospital mortality were firearm, pedestrian and motor vehicle transportation occupant injuries.

Conclusions

Though a few MOIs increased for all paediatric patients in the study period, disparities persist for several specific populations. As such, injury prevention strategies should be tailored based on age, sex and race or ethnicity, and relevant education and resources should be provided to both children and their adult guardians. Future research should consider additional socioeconomic and community-based characteristics.

Examining contextual differences in suicide

Objective

To evaluate differences in mental health and substance use circumstances by rurality and military affiliations among suicide decedents.

Methods

Multiyear (2009–2019) cross-sectional study of adult suicide decedents reported to the National Violent Death Reporting System. We classified suicide decedents into a four-level variable by geography (urban/rural) and military status and evaluated the prevalence of current and past alcohol and substance use problems, mental health problem recognition and mental illness treatment. We estimated prevalence ratios using multiple imputation chain equations to account for missing data and log-binomial regression models and present stratified estimates by military and rural classification.

Findings

There was no significant relationship between rural-military classification and alcohol use problem. Compared with urban civilians, other groups had a lower risk identified of having a substance use problem: urban military (adjusted prevalence ratio (aPR): 0.65; 95% CI: 0.60 to 0.71), rural military (aPR: 0.57; 95% CI: 0.50 to 0.66) and rural civilians (aPR: 0.95; 95% CI: 0.90 to 1.00). Recognition of a mental health problem was lower among both rural military (aPR: 0.88; 95% CI: 0.81 to 0.96) and rural civilians (aPR: 0.89; 95% CI: 0.86 to 0.92). The likelihood of current mental treatment was lower in other groups (urban military (aPR: 0.93; 95% CI: 0.89 to 0.96); rural military (aPR: 0.87; 95% CI: 0.81 to 0.94); and rural civilian (aPR: 0.89; 95% CI: 0.85 to 0.92)). There was no evidence of effect modification by military and rural classification for any outcome.

Conclusions

Mental health outcomes by military affiliation and urbanicity/rurality may need to be independently assessed as social determinants of health.

Spatial de-concentration of firearm violence in Boston

It is a “law” of criminology that urban crime chronically recurs at the same microplaces (i.e., street segments and intersections). An influential study found high concentrations of firearm violence at micropl…

Unintentional firearms mortality disparities across states ’01-21

Background

Firearms kill over 130 Americans daily. Most deaths are the result of intentional acts, but in 2021, 549 deaths (1.5 deaths/day) were unintentional. Strategies to prevent unintentional versus intentional firearms deaths differ. This study describes unintentional firearm-related mortality across the US states and within individual states between 2001 and 2021 and considers factors that might explain disparities across states.

Methods

Unintentional firearms mortality from 2001 to 2021, both for the full country and by state, was obtained online along with data for five state-level predictors: rurality, non-white population, poverty, population and gun ownership.

Results

The highest unintentional firearm-related mortality rates clustered in Southeastern states, followed by states in the Northern Plains and Mountain West. The lowest rates were in the Northeast, followed by scattered states in the West and Midwest. At the state level, unintentional firearms mortality correlated positively with per cent below the poverty level (r=0.54, p<0.01), rural (r=0.59, p<0.01) and owning firearms (r=0.72, p<0.01). In a multivariable regression model predicting unintentional firearms mortality by state, three factors emerged as significant: per cent white (β=–0.22, p<0.05), below the poverty level (β=0.43, p<0.01) and owning firearms (β=0.54, p<0.01).

Conclusions

Large disparities exist across the 50 US states in unintentional firearms mortality. Crude rates in the most afflicted states are ~10 times those in the least afflicted states. Nationwide, over 12 000 lives were lost to unintentional firearms mortality between 2001 and 2021. Factors that create disparities are multifaceted and include rurality, poverty and firearms ownership.

Gun violence exposure and population health inequality

This essay establishes a conceptual framework to understand how direct, secondary and community exposures to gun violence converge to influence population health. Our framework asserts that persistent gun violence in structurally disadvantaged communities enacts broad consequences for mental, physical and behavioural health, operating as a key driver of racial and socioeconomic health disparities. We discuss the applications of this framework for research and improved data collection with a focus on establishing timely and accurate measures of gun violence alongside individual and community health measures. We then address the policy implications of the framework, emphasising the need for long-term, institutional investment in gun violence prevention and intervention, survivor service provision and evidence-based policies at all levels of government.