Firearm legislation, gun violence, and mortality in children and young adults: A retrospective cohort study of 27,566 children in the USA
Firearm legislation, gun violence, and mortality in children and young adults: A retrospective cohort study of 27,566 children in the USA
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DOI：
10.1016/j.ijsu.2018.07.010
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发表时间：
2018-09-01
影响因子：
15.3
通讯作者：
Alban, Rodrigo F.
中科院分区：
文献类型：
--
作者：
Tseng, Joshua;Nuno, Miriam;Alban, Rodrigo F.
背景：枪支暴力每年导致美国数千名儿童死亡。枪支立法对枪支暴力的影响公布，但广泛contested.Materials和方法：从2000年到2009年的儿童住院数据库进行查询，以捕捉诊断为火器相关伤害的儿童住院。根据布雷迪国家记分卡将案件分为五个枪支立法严格程度等级。伤害的趋势进行了探讨，在立法实力，年龄和race.Results：27,566儿童分析的研究。大多数是15-19岁的青少年（87.3%），男性（89.7%）和黑人（53.7%）。意外伤害的比例相对于州法律宽松（R2 = 0.90）增加，与严格（16.7%）相比，宽松州（33.2%）的比例最高。在法律宽松的州，自杀未遂的比例（4.4%）高于严格的州（1.3%）。事故与年龄呈负相关（0-4岁为59.3%，青少年为22.0%），而攻击与年龄呈正相关（0-4岁为31.6%，青少年为66.6%）。白人最有可能出现意外伤害（44.6%），黑人和西班牙裔人最有可能出现袭击（68.2%和75.6%）。种族（p = 0.009），年龄（P < 0.001），火器伤类型（p = 0.001）与死亡率相关;西班牙裔（OR 1.36，95% CI：1.03-1.78），5-9岁儿童（2.03，1.30-3.17）和自杀企图（15.6，11.6-20.9）有较高的院内死亡率。住院儿童中与枪支有关的伤害类型与年龄、种族和州一级的立法有关。事故在幼儿、白人和枪支法宽松的州最常见，而自杀企图在青少年、白人和枪支法宽松的州更常见。自杀企图也与院内死亡率的最大可能性有关。为了解决枪支暴力问题，应考虑制定立法，促进安全的枪支储存行为，并限制儿童获得枪支。
Background: Firearm violence results in the death of thousands of children in the US annually. The effects of firearm legislation on gun violence are published but widely contested.Materials and Methods: The Kid's Inpatient Database from 2000 to 2009 were queried to capture hospitalizations of children diagnosed with a firearm-related injury. Cases were categorized into five levels of firearm legislation strictness by Brady State Scorecard. Trends of injuries were explored in terms of legislative strength, age, and race.Results: 27,566 children analyzed in the study. Most were adolescents aged 15-19 (87.3%), male (89.7%), and black (53.7%). The proportion of accidental injuries increased relative to state law leniency (R 2 = 0.90), with highest percentage in lenient states (33.2%) compared to strict (16.7%). The proportion of suicide attempts were higher in states with lenient laws (4.4%) compared to strict (1.3%). Accidents were inversely related to age (59.3% in ages 0-4 compared to 22.0% in adolescents), while assaults were positively related to age (31.6% in ages 0-4 compared to 66.6% in adolescents). Whites were most likely to present with accidental injuries (44.6%), and Blacks and Hispanics with assaults (68.2% and 75.6%). Race (p = 0.009), age (p < 0.001), and firearm injury type (p = 0.001) were associated with mortality; Hispanics (OR 1.36, 95% CI: 1.03-1.78), children age 5-9 (2.03, 1.30-3.17) and suicide attempts (15.6, 11.6-20.9) had higher odds of in-hospital mortality.Conclusions: Firearm-related injuries types in hospitalized children are associated with age, race, and state level legislation. Accidents are most prevalent in young children, Whites, and states with lenient gun laws, while suicide attempts are more common in adolescents, Whites, and states with lenient gun laws. Suicide attempts are also associated with the greatest odds of in-hospital mortality. To address firearm violence, consideration should be given to legislation that promote safe gun storage behaviors and restrict firearm accessibility to children.