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Magee LA, Ortiz D, Macy JT, Tolliver S, Alvarez-Del-Pino J, Kaur A, Spivey E, Grommon E. Identifying overlaps and disconnects between media reports and official records of nonfatal firearm injuries in Indianapolis, Indiana, 2021-2022. Prev Med 2024; 180:107892. [PMID: 38342384 PMCID: PMC10919894 DOI: 10.1016/j.ypmed.2024.107892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/19/2024] [Accepted: 02/08/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE Open-source data systems, largely drawn from media sources, are commonly used by scholars due to the lack of a comprehensive national data system. It is unclear if these data provide an accurate and complete representation of firearm injuries and their context. The study objectives were to compare firearm injuries in official police records with media reports to better identify the characteristics associated with media reporting. METHODS Firearm injuries were identified in open-source media reports and compared to nonfatal firearm injury (n = 1642) data from official police records between January 1, 2021 to December 31, 2022 in Indianapolis, Indiana. Events were matched on date, location, and event circumstances. Four multivariate, multi-level mixed effects logistic regression models were conducted to assess which survivor, event, and community characteristics were associated with media reporting. Data were analyzed 2023 - January 2024. RESULTS Media reported 41% of nonfatal shootings in 2021 and 45% in 2022(p < 0.05), which is approximately two out of every five shootings. Shootings involving multiple survivors, children, and self-defense were more likely to be reported, whereas unintentional shootings and shootings that occurred in structurally disadvantaged communities were less likely to be reported. CONCLUSIONS Findings suggest that relying on media reports of firearm injuries alone may misrepresent the numbers and contexts of shootings. Public health interventions that educate journalists about these important issues may be an impactful firearm violence prevention strategy. Also, it is critical to link data systems at the local level to ensure interventions are designed and evaluated using accurate data.
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Affiliation(s)
- Lauren A Magee
- Indiana University Indianapolis, O'Neill School of Public and Environmental Affairs, 801 W. Michigan Street, Indianapolis, IN 46204, United States.
| | - Damaris Ortiz
- Indiana University School of Medicine, Department of Surgery, 545 Barnhill Dr, Emerson Hall, Indianapolis, IN 46202, United States; Sidney & Lois Eskenazi Hospital Smith Level One Trauma Center, 720 Eskenazi Ave, Indianapolis, IN 46202, United States
| | - Jonathan T Macy
- Indiana University Bloomington, School of Public Health, 1025 E. Seventh Street, Bloomington, IN 47405, United States
| | - Savannah Tolliver
- Indiana University Indianapolis, O'Neill School of Public and Environmental Affairs, 801 W. Michigan Street, Indianapolis, IN 46204, United States
| | - Jara Alvarez-Del-Pino
- Indiana University School of Medicine, Indiana University, 340 W 10(th) St, Indianapolis, IN 46202, United States
| | - Amarpreet Kaur
- Indiana University Indianapolis, O'Neill School of Public and Environmental Affairs, 801 W. Michigan Street, Indianapolis, IN 46204, United States
| | - Erin Spivey
- Indiana University Indianapolis, O'Neill School of Public and Environmental Affairs, 801 W. Michigan Street, Indianapolis, IN 46204, United States
| | - Eric Grommon
- Indiana University Indianapolis, O'Neill School of Public and Environmental Affairs, 801 W. Michigan Street, Indianapolis, IN 46204, United States
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Webb PB, Jimenez J, Elder A, Cotte AO, Ravichandran A, Holbrook E, Baer RD, Wilson JW. Exploring lived experiences of gunshot wound survivors: A key to ethnographically informed public health interventions for curbing firearm violence. Injury 2024; 55:111240. [PMID: 38159335 DOI: 10.1016/j.injury.2023.111240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024]
Abstract
INTRO The high rates of gun violence in the United States are a recognized public health concern with increased attention since the 1990's. The predominant studies used in gun violence research have been epidemiological approaches and quantitative analyses. This study, instead, examines lived experiences of gunshot wound survivors to better understand their situations. This study also compared the different census categories and their types of gunshot wound injuries. Ethnographic informed analyses may inform public health interventions to decrease firearm injuries. METHODS Data was collected through a series of semi-structured interviews at the emergency department of an urban, Level-1, academic trauma center. 96 patients with gunshot wounds (GSWs) from 2018-2022 were included in the study. Thematic analysis was conducted after coding interview responses. RESULTS There was a significant difference found between the 2 census categories (White and Minority populations). Those who self-identified as white had more self-inflicted GSWs (6) than other groups. Those who self-identified in the minority population had more GSWs as a result of an altercation (36) or as an innocent bystander (20). Interview data also demonstrated a trend in changing opinions about firearms in a group of participants with remote previous gunshot wounds (pGSW). When compared to the acute gunshot wound group (aGSW) the previous gunshot wound group (pGSW) responses showed support for increased gun safety and policies that limit firearm access. CONCLUSION Different injury patterns between census groups demonstrates that multiple public health approaches will be needed to decrease firearm violence. Ethnographically informed approaches, including the support of people with previous GSW injuries, may help craft those interventions to reduce injury. Matched peer support programs represent one potential intervention to decrease secondary injury and firearm violence.
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Affiliation(s)
- Paul Bryce Webb
- Morsani College of Medicine, University of South Florida, United States
| | - Jack Jimenez
- Morsani College of Medicine, University of South Florida, United States
| | - Andre Elder
- Morsani College of Medicine, University of South Florida, United States
| | | | | | - Emily Holbrook
- Department of Anthropology, University of South Florida, United States; Department of Emergency Medicine, Morsani College of Medicine, University of South Florida, Tampa General Hospital, United States
| | - Roberta D Baer
- Department of Anthropology, University of South Florida, United States
| | - Jason W Wilson
- Department of Anthropology, University of South Florida, United States; Department of Emergency Medicine, Morsani College of Medicine, University of South Florida, Tampa General Hospital, United States.
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Toigo S, Pollock NJ, Liu L, Contreras G, McFaull SR, Thompson W. Fatal and non-fatal firearm-related injuries in Canada, 2016-2020: a population-based study using three administrative databases. Inj Epidemiol 2023; 10:10. [PMID: 36788597 PMCID: PMC9930327 DOI: 10.1186/s40621-023-00422-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/05/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Firearms are a substantial cause of injury-related morbidity and mortality in Canada and globally, though evidence from contexts other than the USA is relatively limited. We examined deaths, hospitalizations and emergency department (ED) visits due to firearm-related injuries in Canada to identify population groups at increased risk of fatal and non-fatal outcomes. METHODS We conducted a population-based study using three national administrative databases on deaths, hospitalizations, and ED visits. ICD-10 codes were used to identify firearm-related injuries from January 1, 2016, through December 31, 2020. Fatal and non-fatal firearm injuries were classified as suicide/self-harm, homicide/assault, unintentional, undetermined or legal intervention injuries. We analyzed the data with counts, rates and proportions, stratified by sex, age group, province/territory, and year. RESULTS Over the 5-year period, we identified 4005 deaths, 3169 hospitalizations, and 2847 ED visits related to firearm injuries in various jurisdictions in Canada. Males comprised the majority of fatal and non-fatal injury cases. The highest rates of fatal and non-fatal firearm injuries were among 20- to 34-year-olds. The leading cause of fatal firearm injuries was self-harm (72.3%). For non-fatal firearm hospitalizations and ED visits, assault (48.8%) and unintentional injuries (62.8%) were the leading causes of injury. Rates varied by province and territory. CONCLUSIONS Our results showed that males comprised the majority of fatal and non-fatal firearm injuries in Canada. The rates of both fatal and non-fatal firearm injuries were highest among the 20- to 34-year-old age group. This comprehensive overview of the epidemiology of firearm injuries in Canada provides baseline data for ongoing surveillance and policy evaluation related to public health interventions.
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Affiliation(s)
- Stephanie Toigo
- Injury Surveillance, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1S 5H4, Canada.
| | - Nathaniel J. Pollock
- grid.415368.d0000 0001 0805 4386Injury Surveillance, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1S 5H4 Canada
| | - Li Liu
- grid.415368.d0000 0001 0805 4386Injury Surveillance, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1S 5H4 Canada
| | - Gisèle Contreras
- grid.415368.d0000 0001 0805 4386Injury Surveillance, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1S 5H4 Canada
| | - Steven R. McFaull
- grid.415368.d0000 0001 0805 4386Injury Surveillance, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1S 5H4 Canada
| | - Wendy Thompson
- grid.415368.d0000 0001 0805 4386Injury Surveillance, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1S 5H4 Canada
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Barber C, Cook PJ, Parker ST. The emerging infrastructure of US firearms injury data. Prev Med 2022; 165:107129. [PMID: 35803350 DOI: 10.1016/j.ypmed.2022.107129] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/18/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022]
Abstract
For every fatal shooting in the United States, detailed information from reports of coroners or medical examiners, police departments, and other sources is recorded in the National Violent Death Reporting System. There is no such system in place for nonfatal shootings, which far outnumber fatalities. Hospital data systems are in place that could, with some improvements, provide access to reliable local, state and national estimates of firearm injuries. Such estimates are possible because most firearms injuries are treated in hospitals, and hospitals routinely assign "external cause of injury" codes to all injury encounters. Federal health agencies supervise a number of data systems that centralize hospital data. Challenges currently being addressed are public access, timeliness, and accuracy of coding of intent. (Hospitals misclassify many firearm assaults as accidents.) Law enforcement agencies provide detailed data on shootings in criminal circumstances, including shootings that are not treated in a hospital. The FBI's Uniform Crime Reports (UCR) system aggregates data from agencies. The FBI instituted a radical reform of this system beginning in 2021, resulting in a sharp agency participation drop that prevents valid national estimates. The reform requires agencies to report incident-level data instead of summary counts, which is all that was required for the previous 90 years. There are ongoing efforts to increase participation in the new system and restore its former status as the leading source of national crime estimates. In the meantime, data on nonfatal gunshot cases are available from a number of police departments. We discuss additional reforms needed to generate timely, accurate, publicly accessible data from hospitals and police.
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Affiliation(s)
- Catherine Barber
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States of America.
| | - Philip J Cook
- Sanford School of Public Policy, Duke University, Durham, NC 27708, United States of America.
| | - Susan T Parker
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America.
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5
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Magee LA, Ray B, Huynh P, O'Donnell D, Ranney ML. Dual public health crises: the overlap of drug overdose and firearm injury in Indianapolis, Indiana, 2018-2020. Inj Epidemiol 2022; 9:20. [PMID: 35781347 PMCID: PMC9252058 DOI: 10.1186/s40621-022-00383-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/24/2022] [Indexed: 12/01/2022] Open
Abstract
Background Drug overdose and firearm injury are two of the United States (US) most unrelenting public health crises, both of which have been compounded by the COVID-19 pandemic. Programs and policies typically focus on each epidemic, alone, which may produce less efficient interventions if overlap does exist. The objective is to examine whether drug overdose correlates with and is associated with firearm injury at the census tract level while controlling for neighborhood characteristics. Methods An ecological study of census tracts in Indianapolis, Indiana from 2018 to 2020. Population rates per 100,000 and census tracts with the highest overlap of overdose and firearm injury were identified based on spatial clusters. Bivariate association between census tract characteristic and drug overdose and firearm violence rate within spatial clusters. Zero-inflated negative binominal regression was used to estimate if the drug overdose activity is associated with higher future firearm injury. Results In high overdose—high firearm injury census tracts, rates of firearm injury and drug overdose are two times higher compared to city wide rates. Indicators of structural disadvantage and structural racism are higher in high overdose—high firearm injury census tracts compared to city-wide averages. Drug overdoses are associated with higher rates of firearm injury in the following year (IRR: 1.004, 95% CI 1.001, 1.007, p < 0.05), adjusting for census tract characteristics and spatial dependence. Conclusions Drug overdose and firearm injury co-spatially concentrate within census tracts. Moreover, drug overdoses are associated with future firearm injury. Interventions to reduce firearm injuries and drug overdoses should be a co-response in high drug overdose—high firearm injury communities.
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Affiliation(s)
- Lauren A Magee
- O'Neill School of Public and Environmental Affairs, Indiana University Purdue University Indianapolis, 801 W Michigan St, Rm 4058, Indianapolis, IN, 46202, USA.
| | - Bradley Ray
- Division for Applied Justice Research, RTI International, 3040 Cornwallis Road, Research Triangle Park, Durham, NC, 27709, USA
| | - Philip Huynh
- Center for Behavioral Health and Justice, Wayne State University School of Social Work, 5201 Cass Avenue, Prentis, Suite 226, Detroit, MI, 48202, USA
| | - Daniel O'Donnell
- Indiana University School of Medicine, Indianapolis Emergency Medical Services, 3930 Georgetown Rd., Indianapolis, IN, 46254, USA
| | - Megan L Ranney
- School of Public Health and Alpert School of Medicine, Brown University, 121 S Main St, Providence, RI, 02903, USA
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Hullenaar KL, Lyons VH, Shepherd JP, Rowhani-Rahbar A, Vavilala MS, Rivara FP. Assault-related injuries reported to police and treated by healthcare providers in the United States. Prev Med 2022; 159:107060. [PMID: 35460720 DOI: 10.1016/j.ypmed.2022.107060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 11/17/2022]
Abstract
Research suggests that assault-related injuries known by the police significantly differ from those known by healthcare providers, but the magnitude and nature of these differences are poorly understood. To address this gap, our study examined the empirical differences between assault-related injuries reported to police and treated by healthcare providers. In June of 2021, we analyzed the National Crime Victimization Survey (1993-2019) to estimate the prevalence of police reporting and healthcare use among 5093 nonfatal victimizations that caused injury and were either reported to the police or treated by healthcare in the United States. Quasi-Poisson models identified the factors associated with whether people who sustained the injuries used healthcare (v. only reported to police) and reported to police (v. only used healthcare). Among victimizations that caused only minor injuries, 43% involved only a police report, 11% involved only healthcare, and 46% involved both services. Among victimizations that caused serious injuries, 14% involved only a police report, 13% involved only healthcare, and 73% involved both services. Whether people with violent injuries used healthcare (v. only reported to police) and reported to police (v. only used healthcare) was significantly associated with 13 different person- and incident-level factors. The number and nature of assault-related injuries reported to law enforcement significantly differ from those treated by healthcare providers. Therefore, public health efforts to link police and healthcare data are warranted and recommended.
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Affiliation(s)
- Keith L Hullenaar
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, United States of America; Department of Epidemiology, University of Washington, Seattle, WA, United States of America.
| | - Vivian H Lyons
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, United States of America; Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States of America
| | - Jonathan P Shepherd
- Crime and Security Research Institute, Cardiff University, Cardiff, Wales, United Kingdom
| | - Ali Rowhani-Rahbar
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, United States of America; Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, United States of America; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States of America
| | - Frederick P Rivara
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, United States of America; Department of Pediatrics, University of Washington, Seattle, WA, United States of America
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7
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Hipple NK. Towards a National Definition and Database for Nonfatal Shooting Incidents. J Urban Health 2022; 99:361-372. [PMID: 35469106 PMCID: PMC9187788 DOI: 10.1007/s11524-022-00638-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
After a decades-long decline, criminal gun violence has increased dramatically in many parts of the USA. Most victims survive their gunshot wounds; however, research and data collection focus primarily on fatal events. In fact, there is no official national definition of a nonfatal shooting incident, nor a repository of these data. This definitional oversight inhibits data-informed policy and practice. The current study involves two data sources: fatal and nonfatal shooting incidents recorded in an internal metropolitan police database and official Uniform Crime Reporting (UCR) violent crime data. Shooting incidents in the police database were matched to incidents in the UCR data to determine how they were officially categorized and reported to the FBI. The majority (82.0%) of nonfatal shooting incidents in the UCR data were recorded as Aggravated Assault-Gun, while 16.5% were classified as a violent crime other than an Aggravated Assault-Gun. The UCR data were missing 1.5% of the nonfatal shooting incidents documented by the police database. Almost four-fifths (79.7%) of all Aggravated Assault-Gun incidents in the UCR data did not meet the suggested definition of a nonfatal shooting incident. Overall, official crime statistics are not a good data source for nonfatal shooting incidents. A holistic response to criminal gun violence requires comprehensive, valid, and reliable data collection on all shooting incidents, especially those incidents in which a person is injured by gunfire. Establishing a national definition for a nonfatal shooting incident is the first important step toward effective gun violence prevention and reduction.
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Affiliation(s)
- Natalie Kroovand Hipple
- Department of Criminal Justice, Indiana University, 1033 East Third Street, 309 Sycamore Hall, Bloomington, IN, 47405, USA.
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Salhi BA, Zeidan A, Stehman CR, Kleinschmidt S, Liu EL, Bascombe K, Preston‐Suni K, White MH, Druck J, Lopez BL, Samuels‐Kalow ME. Structural competency in emergency medical education: A scoping review and operational framework. AEM EDUCATION AND TRAINING 2022; 6:S13-S22. [PMID: 35783075 PMCID: PMC9222890 DOI: 10.1002/aet2.10754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Existing curricula and recommendations on the incorporation of structural competency and vulnerability into medical education have not provided clear guidance on how best to do so within emergency medicine (EM). The goal of this scoping review and consensus building process was to provide a comprehensive overview of structural competency, link structural competency to educational and patient care outcomes, and identify existing gaps in the literature to inform curricular implementation and future research in EM. METHODS A scoping review focused on structural competency and vulnerability following Arksey and O'Malley's six-step framework was performed in concurrence with a multistep consensus process culminating in the 2021 SAEM Consensus Conference. Feedback was incorporated in developing a framework for a national structural competency curriculum in EM. RESULTS A literature search identified 291 articles that underwent initial screening. Of these, 51 were determined to be relevant to EM education. The papers consistently conceptualized structural competency as an interdisciplinary framework that requires learners and educators to consider historical power and privilege to develop a professional commitment to justice. However, the papers varied in their operationalization, and no consensus existed on how to observe or measure the effects of structural competency on learners or patients. None of the studies examined the structural constraints of the learners studied. CONCLUSIONS Findings emphasize the need for training structurally competent physicians via national structural competency curricula focusing on standardized core competency proficiencies. Moreover, the findings highlight the need to assess the impact of such curricula on patient outcomes and learners' knowledge, attitudes, and clinical care delivery. The framework aims to standardize EM education while highlighting the need for further research in how structural competency interventions would translate to an ED setting and affect patient outcomes and experiences.
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Affiliation(s)
- Bisan A. Salhi
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
- Department of AnthropologyEmory UniversityAtlantaGeorgiaUSA
| | - Amy Zeidan
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Christine R. Stehman
- Department of Emergency MedicineUniversity of Illinois College of MedicinePeoriaIllinoisUSA
| | - Sarah Kleinschmidt
- Department of Emergency MedicineUniversity of Massachusetts Medical School—BaystateSpringfieldMassachusettsUSA
| | - E. Liang Liu
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Kristen Bascombe
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Kian Preston‐Suni
- Department of Emergency MedicineVA Greater Los Angeles Healthcare SystemUniversity of California at Los AngelesLos AngelesCaliforniaUSA
| | - Melissa H. White
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Jeff Druck
- Department of Emergency MedicineUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Bernard L. Lopez
- Department of Emergency MedicineSidney Kimmel Medical CollegePhiladelphiaPennsylvaniaUSA
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Magee LA, Dennis Fortenberry J, Aalsma MC, Gharbi S, Wiehe SE. Healthcare utilization and mental health outcomes among nonfatal shooting assault victims. Prev Med Rep 2022; 27:101824. [PMID: 35656226 PMCID: PMC9152773 DOI: 10.1016/j.pmedr.2022.101824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 05/03/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
Victims of nonfatal shooting (NFS) assaults suffer from emotional and physical trauma; however, little is understood about clinical care utilization patterns among victims. This study examines the healthcare utilization and mental health outcomes before and after an index NFS victimization. A longitudinal dataset of police and clinical data were linked at the individual level to define a cohort of NFS victims with one or more clinical encounter in the 24-months preceding an index NFS injury (N = 2,681) in Indianapolis, Indiana between 2005 and 2018. Mental health was defined using ICD diagnosis codes from any emergency department, inpatient, or outpatient encounter and clinical care utilization was the number of unique encounters within the 24-months preceding and following an index NFS injury. Multivariable logistic regression was conducted to examine factors associated with a mental health diagnosis in the post injury period. Analyses were conducted in October 2021-March 2022. Overall clinical care utilization (Mean: pre = 277.7 (SD 235.3) vs. post = 333.9 (SD 255.1), p < 0.001) and mental health prevalence (14.4% pre vs. 18.8% post, p < 0.001) increased in the 24-months following an index NFS compared to the prior 24-months. Preinjury mental health utilization increased the odds of receiving a mental health diagnosis in the 24-months following an index NFS injury - particularly for Black victims (Odds Ratio 1.69, 95% CI 1.01, 2.85). The findings indicate missed opportunities within the healthcare system to connect NFS victims with needed mental health services, as well as the importance of premorbid connection to mental health care.
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Affiliation(s)
- Lauren A. Magee
- O’Neill School of Public and Environmental Affairs, Indiana University Purdue University – Indianapolis, 801 W. Michigan Street, Indianapolis, IN 46204, USA
| | - J. Dennis Fortenberry
- Department of Adolescent Medicine, Indiana University School of Medicine, 410 W. 10 Street, Indianapolis, IN 46204, USA
| | - Matthew C. Aalsma
- Department of Pediatrics, Indiana University School of Medicine, 410 W. 10 Street, Indianapolis, IN 46204, USA
| | - Sami Gharbi
- Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, 410 W. 10 Street, Indianapolis, IN 46204, USA
| | - Sarah E. Wiehe
- Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, 410 W. 10 Street, Indianapolis, IN 46204, USA
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Feinglass J, Patel TR, Rydland K, Sheehan K. Trends in Hospital Care for Intentional Assault Gunshot Wounds Among Residents of Cook County, Illinois, 2018-2020. Am J Public Health 2022; 112:795-802. [PMID: 35324258 PMCID: PMC9010903 DOI: 10.2105/ajph.2022.306747] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To examine gun violence with respect to hospital visits for treatment of intentional assault gunshot wounds (IGWs). Methods. IGW-coded visits among residents of Cook County, Illinois, were matched to census zip code tabulation areas (ZCTAs) to map changes in IGW visit frequencies between 2018 and 2020. Patient characteristics were compared across years, and Poisson regression models for the likelihood of an inpatient admission or in-hospital death were estimated. Results. Over the study period, Cook County residents made 7122 IGW-coded hospital visits to 89 Illinois hospitals, resulting in $342 million in charges and 24 894 hospital days. The number of visits almost doubled between 2018 and 2020, from 1553 to 3031; 6 ZCTAs had increases of more than 60 visits. Approximately one third of patients with a visit were admitted, and 6.5% died. Conclusions. Hospital statistics do not include the full toll of nonfatal gun injuries or the costs of related community-level trauma. The health care system remains crucial in implementing epidemiological approaches to violence prevention. Addressing the national spike in shootings will require large investments in community economic development and a professional public safety workforce. (Am J Public Health. 2022;112(5):795-802. https://doi.org/10.2105/AJPH.2022.306747).
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Affiliation(s)
- Joe Feinglass
- Joe Feinglass is with the Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL. Tulsi R. Patel is with the Masters in Public Health Degree Program, Northwestern University Feinberg School of Medicine. Kelsey Rydland is with the Northwestern University Library. Karen Sheehan is with the Department of Pediatric Emergency Medicine, Northwestern University Feinberg School of Medicine
| | - Tulsi R Patel
- Joe Feinglass is with the Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL. Tulsi R. Patel is with the Masters in Public Health Degree Program, Northwestern University Feinberg School of Medicine. Kelsey Rydland is with the Northwestern University Library. Karen Sheehan is with the Department of Pediatric Emergency Medicine, Northwestern University Feinberg School of Medicine
| | - Kelsey Rydland
- Joe Feinglass is with the Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL. Tulsi R. Patel is with the Masters in Public Health Degree Program, Northwestern University Feinberg School of Medicine. Kelsey Rydland is with the Northwestern University Library. Karen Sheehan is with the Department of Pediatric Emergency Medicine, Northwestern University Feinberg School of Medicine
| | - Karen Sheehan
- Joe Feinglass is with the Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL. Tulsi R. Patel is with the Masters in Public Health Degree Program, Northwestern University Feinberg School of Medicine. Kelsey Rydland is with the Northwestern University Library. Karen Sheehan is with the Department of Pediatric Emergency Medicine, Northwestern University Feinberg School of Medicine
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11
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Magee LA, Lucas B, Fortenberry JD. Changing epidemiology of firearm injury: a cohort study of non-fatal firearm victimisation before and during the COVID-19 pandemic, Indianapolis, Indiana. BMJ Open 2022; 12:e059315. [PMID: 35321899 PMCID: PMC8943482 DOI: 10.1136/bmjopen-2021-059315] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To examine victimisation rates, geographic patterns and neighbourhood characteristics associated with non-fatal firearm injury rates before and during the COVID-19 pandemic. DESIGN A retrospective cohort study. SETTING City of Indianapolis, Indiana, USA, 1 January 2017-30 June 2021. PARTICIPANTS Intentional non-fatal firearm injury victims from Indianapolis Metropolitan Police Department records. The study included information on 2578 non-fatal firearm injury victims between ages 0 and 77 years. Of these victims, 82.5% were male and 77.4% were black. PRIMARY AND SECONDARY OUTCOME MEASURES Rates of non-fatal firearm injuries per 100 000 population by victim age, race, sex and incident motive. Prepandemic and peripandemic non-fatal firearm injury rates. RESULTS Non-fatal shooting rates increased 8.60%, from 57.0 per 100 000 person-years in prepandemic years to 65.6 per 100 000 person-years during the pandemic (p<0.001). Rates of female victims (15.2 vs 23.8 per 100,000; p<0.001) and older victims (91.3 vs 120.4 per 100,000; p<0.001) increased significantly during the pandemic compared with the prepandemic period. Neighbourhoods with higher levels of structural disadvantage (IRR: 1.157, 95% CI 1.012 to 1.324) and prepandemic firearm injury rates (IRR: 1.001, 95% CI 1.001 to 1.002) was positively associated with higher rates of non-fatal firearm injuries during the pandemic, adjusting for neighbourhood characteristics. CONCLUSIONS Non-fatal firearm injuries increased significantly during the COVID-19 pandemic, particularly among female and older victims. Efforts are needed to expand and rethink current firearm prevention efforts that both address the diversification of victimisation and the larger societal trauma of firearm violence.
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Affiliation(s)
- Lauren A Magee
- O'Neill School of Public and Environmental Affairs, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Bailee Lucas
- O'Neill School of Public and Environmental Affairs, Indiana University Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - James Dennis Fortenberry
- Department of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Miller KR, Egger ME, Pike A, Burden J, Bozeman MC, Franklin GA, Nash NA, Smith JW, Harbrecht BG, Benns MV. The limitations of hospital and law enforcement databases in characterizing the epidemiology of firearm injury. J Trauma Acute Care Surg 2022; 92:82-87. [PMID: 34284466 DOI: 10.1097/ta.0000000000003367] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Current data on the epidemiology of firearm injury in the United States are incomplete. Common sources include hospital, law enforcement, consumer, and public health databases, but each database has limitations that exclude injury subgroups. By integrating hospital (inpatient and outpatient) and law enforcement databases, we hypothesized that a more accurate depiction of the totality of firearm injury in our region could be achieved. METHODS We constructed a collaborative firearm injury database consisting of all patients admitted as inpatients to the regional level 1 trauma hospital (inpatient registry), patients treated and released from the emergency department (ED), and subjects encountering local law enforcement as a result of firearm injury in Jefferson County, Kentucky. Injuries recorded from January 1, 2016, to December 31, 2020, were analyzed. Outcomes, demographics, and injury detection rates from individual databases were compared with those of the combined collaborative database and compared using χ2 testing across databases. RESULTS The inpatient registry (n = 1,441) and ED database (n = 1,109) were combined, resulting in 2,550 incidents in the hospital database. The law enforcement database consisted of 2,665 patient incidents, with 2,008 incidents in common with the hospital database and 657 unique incidents. The merged collaborative database consisted of 3,207 incidents. In comparison with the collaborative database, the inpatient, total hospital (inpatient and ED), and law enforcement databases failed to include 55%, 20%, and 17% of all injuries, respectively. The hospital captured nearly 94% of survivors but less than 40% of nonsurvivors. Law enforcement captured 93% of nonsurvivors but missed 20% of survivors. Mortality (11-26%) and injury incidence were markedly different across the databases. DISCUSSION The utilization of trauma registry or law enforcement databases alone do not accurately reflect the epidemiology of firearm injury and may misrepresent areas in need of greater injury prevention efforts. LEVEL OF EVIDENCE Epidemiological, level IV.
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Affiliation(s)
- Keith R Miller
- From the University of Louisville Department of Surgery (K.R.M., M.E.E., M.C.B., G.A.F., N.A.N., J.W.S., B.G.H., M.V.B.), University of Louisville School of Medicine; and University of Louisville Health, University of Louisville Hospital, Trauma Institute (A.P., J.B.), Louisville, Kentucky
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