Pediatric Firearm Deaths: A Mixed-Methods Analysis of Individual- and Situation-Level Factors Contributing to Racial and Ethnic Disparities

项目摘要 在美国，火器伤是儿科发病率和死亡率的主要原因。2018年， 火器造成约6 500名儿童受伤，1 700名儿童死亡。这些死亡中有一半 与他杀有关，40%与自杀有关。直到最近，资金限制阻止了 在这一重要的公共卫生领域的研究进展，以及许多现存的儿科火器文献， 这些数据仅限于使用样本量小和地理范围有限的数据源。因此，在本发明中， 对儿童火器伤害和死亡的研究落后于儿童健康的其他领域。近期 文献主要使用描述性流行病学来解释受伤和死亡的负担， 创伤中心对环境特征和种族/民族差异的了解较少 与涉及枪支的儿童杀人和自杀有关拟议的研究将解决这一差距 在文献中使用的数据来自17个国家报告的国家暴力死亡报告系统 （NVDRS），2014 - 2018年。NVDRS包含600多个与死者，犯罪者，犯罪有关的变量。 场景和法医检查，包括法医和执法叙述。有了这些数据，我们 建议检查家族和环境特征（例如，亲密伴侣暴力、经济暴力 压力，健康问题，药物滥用，帮派活动）与枪支有关的美国儿童死亡， 确定这些因素如何通过使用差异和不一致性措施的种族/民族的变化。 此外，使用混合方法的方法，我们将阐明与枪支有关的死亡情况， 0 - 17岁的美国儿童（例如，杀人、自杀、非故意）。与枪支有关的死亡将是 使用国际疾病分类第10版（ICD-10）和损伤的外部原因确定 代码.使用ICD-10和电子编码未采集的病例将使用其他变量进行识别 在NVDRS内操作（例如，死亡的直接原因，死亡的根本原因）。定性 对法医和执法人员叙述的分析将确定独特的主题并提供背景 使用定量方法表征的关系。为了评估我们结果的普遍性， 敏感性分析将用于比较17个州和50个州的拟议研究结果。 NVDRS在2018年报告。这项研究的长期目标是提供急需的背景， 儿童枪支死亡，可以为未来的研究，政策和实践层面的预防工作提供信息。

PROJECT SUMMARY Firearm injury is a leading cause of pediatric morbidity and mortality in the United States (US). In 2018, firearms were attributed to approximately 6,500 pediatric injuries, and 1,700 child deaths. Half of these deaths were related to homicide, and 40% related to suicide. Until recently, funding restrictions have prevented the evolution of research in this important public health area, and much of the extant pediatric firearm literature has been limited to the use of data sources with small sample sizes and limited geographic scope. As a result, research on pediatric firearm injuries and deaths has lagged behind other areas of pediatric health. The recent literature has predominantly used descriptive epidemiology to explain the burden of injuries and deaths at trauma centers. Less is understood about the circumstantial characteristics and racial/ethnic disparities associated with pediatric homicides and suicides involving firearms. The proposed study will address this gap in the literature using data from the 17 states reporting to the National Violent Death Reporting System (NVDRS) from 2014-2018. The NVDRS contains over 600 variables related to decedents, perpetrators, crime scenes, and forensic exams and includes medical examiner and law enforcement narratives. With this data, we propose to examine the familial and circumstantial characteristics (e.g., intimate partner violence, financial stress, health problems, substance misuse, gang activity) of firearm-related deaths of US children, and determine how these factors vary by race/ethnicity using measures of disparity and disproportionality. Additionally, using a mixed methods approach, we will elucidate the circumstances of firearm-related deaths in US children aged 0-17 years by intent (e.g., homicide, suicide, unintentional). Firearm-related deaths will be identified using International Classification of Diseases, 10th Revision (ICD-10), and external cause of injury codes. Cases not captured using ICD-10 and e-codes will be identified using additional variables operationalized within NVDRS (e.g., immediate cause of death, underlying cause of death). Qualitative analysis of medical examiner and law enforcement narratives will identify unique themes and provide context to the relationships characterized using quantitative methods. To assess the generalizability of our results, sensitivity analysis will be used to compare the results from the proposed study of 17 states with the 50 NVDRS states reporting in 2018. The long-term goal of this study is to provide much-needed context to pediatric firearm deaths that can inform future prevention efforts at the levels of research, policy, and practice.