United States Childhood Gun-Violence – Disturbing Trends

Purpose: We conducted a cross-sectional analysis of household gun ownership and childhood gun-violence across the 50 United States to identify potential areas for policy intervention. We hypothesized that increasing household gun ownership is significantly associated with increasing proportion of childhood gunshot wounds (GSWs) occurring in the home.

Methods: From >36 million pediatric hospitalizations in the Kids' Inpatient Database (KID; 1997, 2000, 2003, 2006, and 2009), we evaluated temporal trends using variance-weighted least squares (vWLS) regression. We estimated state gun ownership using the most recent data from the Behavioral Risk Factor Surveillance System (BRFSS; 2004). vWLS regression assessed the relationship between %-households containing guns (BRFSS2004) and %-childhood GSWs occurring in the home (vs. other locations; KID2009). The β regression coefficient represents an increase (β>0) or decrease (β<0) in %-childhood home GSWs that can be expected for a 1% change in household gun ownership.

Results: Between 1997 and 2009, hospitalizations and in-hospital deaths for GSWs increased from 4270±591 to 7730±498 (P=0.04) and 317±48 to 503±42 (P=0.04), respectively. Over that time, proportion of assaults increased (68.0±3.0% to 78.6±1.0%, P=0.05) and proportion of accidents decreased (15.5±1.9% to 10.8±0.7%, P=0.03). The majority of GSWs occurred on the street (21.3±1.6%) or in a home (19.1±1.4%). Handguns inflicted the majority of GSWs (77.2±1.5%), followed by shotguns (18.5±1.4%) and hunting rifles (3.9±0.5%).

Compared to other emergent hospitalizations in 2009, GSWs incurred higher mortality (6.5±0.3% vs. 0.4±0.0%, P<0.01) and higher mean hospital charges per hospitalization ($70,508±2,835 vs. $23,027±705, P<0.01). Among homes with children, rates of any gun possession, loaded gun possession, and unlocked loaded gun possession ranged from 10-62% (New Jersey-Montana), 1-14% (Massachusetts-Arkansas), and <1%-7% (Massachusetts-Arkansas), respectively. There was a significant association between %-GSWs occurring in the home and %-households containing any firearm (β=0.7, 95% confidence interval [CI]=0.3–1.1, P<0.01), loaded firearms (β =1.7, 95% CI=0.3–3.2, P=0.02), and unlocked loaded firearms (β=2.9, 95% CI=0.6–5.2, P=0.01). Likewise, there was a significant association between %-GSWs occurring in the home and %-households with children containing any firearm (β=0.7, 95% CI=0.3–1.1, P<0.01), loaded firearms (β=2.1, 95% CI=0.1–4.0 P=0.04), and unlocked loaded firearms (β=4.8, 95% CI=1.1–8.5, P=0.01).

Conclusion: Hospitalizations and in-hospital deaths for children with GSWs are increasing. Currently, over 7,500 children are annually hospitalized for GSWs, including over 500 in-hospital deaths. While recent policy proposals to limit military-style semi-automatic assault weapons are important, handguns remain the leading injurious agent and may be a more efficacious target. Household gun ownership and safety practices vary widely by state. There was a significant relationship between %-household gun ownership and %-GSWs occurring in the home. The relationship was dose-dependent with safety measures (any<loaded<unlocked loaded firearm). Policies designed to reduce the number of household firearms, especially handguns, may reduce childhood GSWs.