Epidemiologic Trends in Fatal and Nonfatal Firearm Injuries in the US, 2009-2017
Epidemiologic Trends in Fatal and Nonfatal Firearm Injuries in the US, 2009-2017
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DOI：
10.1001/jamainternmed.2020.6696
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发表时间：
2020-12-07
影响因子：
39
通讯作者：
Delgado, M. Kit
中科院分区：
文献类型：
--
作者：
Kaufman, Elinore J.;Wiebe, Douglas J.;Delgado, M. Kit
在美国，枪支伤害研究主要集中在致命伤害上。与非致命性火器伤害相关的发病率和流行病学因素尚不清楚。目的评价致死性和非致死性火器伤害的发生率及其随时间变化的趋势。设计、环境和参与者使用2009年至2017年美国各地的数据进行了一项横断面生态学研究。来自疾病控制和预防中心的致命伤害数据与来自全国急诊科（ED）样本的非致命火器伤害急诊就诊的国家数据相结合。数据分析时间为2019年8月至2020年9月。根据《国际疾病分类》外因伤害代码确定的火器伤害，并按伤害意图、年龄组和城乡位置进行分类。主要结局和测量：枪支伤害发生率、病死率和随时间变化的趋势，按意图、年龄组和城乡分布。结果2009 - 2017年，平均每年有85 694例非致死性火器伤急诊就诊，34 538例死亡。每年平均有26445例死亡（76.6%）发生在医院外。殴打是最常见的整体机制（38.9%），其次是意外伤害（36.9%）和故意自残（19.6%）。自残占21 128例死亡（61.2%），死亡率最高（89.4%;95% CI, 88.5%-90.4%），其次是殴打（25.9%;95% CI, 23.7%-28.6%）和法律干预（23.4%;95% CI, 21.6%-25.5%）。意外伤害是最常见的非致命性伤害（43 729例[51.0%]），病死率最低（1.2%;95% CI, 1.1%-1.3%）。在研究期间，在农村和城市地区的所有年龄组中，自残死亡人数都有所增加，其中87.8%发生在医院外，在55岁及以上的人群中最为常见。城市地区的致命攻击伤害率高于农村地区（16.6比9.0 / 10万每年），在15至34岁的人群中最高（38.6 / 10万每年）。农村地区的意外伤害率高于城市地区（18.5 / 10万vs 12.4 / 10万）。在这项横断面研究中，自杀似乎是美国枪支伤害死亡的最常见原因，大多数死于自杀的人从未去过医院。这些调查结果表明，袭击和意外伤害是大多数非致命和总体火器伤害的原因，也是在医院接受治疗的大多数伤害的原因。本横断面研究探讨了致命和非致命火器伤害的发生率和趋势的变化与伤害相关的意图。在美国，致命和非致命火器伤害的发生率是多少，包括自残、攻击和意外伤害？在这项对美国全国数据库数据的横断面研究中，从2009年到2017年，每年平均有85 694例非致命性枪支伤害急诊就诊，34 538例枪支伤害死亡。虽然自杀占死亡人数的61%，但自残只占非致命伤害的3%；袭击占死亡人数的35%和非致命伤害的41%，意外伤害占死亡人数的2%和非致命伤害的51%。在美国，非致命性火器伤害的发生率是火器伤害死亡的两倍多；最常见的伤害是死亡中的自残，非致命伤害中的意外伤害，以及总体上的袭击。
Importance Firearm injury research in the US has focused on fatal injuries. The incidence and epidemiologic factors associated with nonfatal firearm injuries are less understood. Objective To evaluate estimates of incidence and trends over time of fatal and nonfatal firearm injuries. Design, Setting, and Participants A cross-sectional, ecologic study was conducted using data throughout the US from 2009 to 2017. Data on fatal injuries from the Centers for Disease Control and Prevention were combined with national data on emergency department visits for nonfatal firearm injury from the Nationwide Emergency Department (ED) sample. Data analysis was conducted from August 2019 to September 2020. Exposures Firearm injuries identified with International Classification of Diseases external cause of injury codes and categorized by intent of injury, age group, and urban-rural location. Main Outcomes and Measures Incidence, case fatality rate, and trends over time of firearm injury according to intent, age group, and urban-rural location. Results From 2009 to 2017, there was a mean of 85 694 ED visits for nonfatal firearm injury and 34 538 deaths each year. An annual mean of 26 445 deaths (76.6%) occurred outside of the hospital. Assault was the most common overall mechanism (38.9%), followed by unintentional injuries (36.9%) and intentional self-harm (19.6%). Self-harm, which accounted for 21 128 deaths (61.2%), had the highest case fatality rate (89.4%; 95% CI, 88.5%-90.4%), followed by assault (25.9%; 95% CI, 23.7%-28.6%) and legal intervention (23.4%; 95% CI, 21.6%-25.5%). Unintentional injuries were the most common nonfatal injuries (43 729 [51.0%]) and had the lowest case fatality rate (1.2%; 95% CI, 1.1%-1.3%). Self-harm deaths, 87.8% of which occurred outside the hospital, increased in all age groups in both rural and urban areas during the study period and were most common among people aged 55 years and older. The rate of fatal assault injuries was higher in urban than in rural areas (16.6 vs 9.0 per 100 000 per year) and highest among people aged 15 to 34 years (38.6 per 100 000 per year). Rates of unintentional injury were higher in rural than in urban areas (18.5 per 100 000 vs 12.4 per 100 000). Conclusions and Relevance In this cross-sectional study, suicide appears to be the most common cause of firearm injury death in the US, and most people who die from suicide never reach the hospital. These findings suggest that assaults and unintentional injuries account for most nonfatal and overall firearm injuries and for most of the injuries that are treated in hospitals.This cross-sectional study examines changes in incidence and trends of fatal and nonfatal firearm injury by intent associated with the injury.Question What is the incidence of fatal and nonfatal firearm injury in the US, including self-harm, assault, and unintentional injury? Findings In this cross-sectional study of data from nationwide US databases, from 2009 to 2017, there was an annual average of 85 694 emergency department visits for nonfatal firearm injury and 34 538 deaths from firearm injury. Although suicide accounted for 61% of deaths, self-harm accounted for only 3% of nonfatal injuries; assaults accounted for 35% of deaths and 41% of nonfatal injuries, and unintentional injuries accounted for 2% of deaths and 51% of nonfatal injuries. Meaning In the US, nonfatal firearm injuries are more than twice as prevalent as deaths from firearm injury; the most common injuries are self-harm among deaths, unintentional injuries among nonfatal injuries, and assaults overall.