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

项目总结 在美国，火器伤是导致儿科发病率和死亡率的主要原因。2018年， 枪支造成约6500名儿童受伤，1700名儿童死亡。这些死亡中有一半是 与凶杀有关，40%与自杀有关。直到最近，资金限制还阻止了 这一重要公共卫生领域的研究进展，以及许多现存的儿科枪支文献 仅限于使用样本量小、地域范围有限的数据源。结果, 关于儿科枪伤和死亡的研究一直落后于儿科卫生的其他领域。最近的 文献主要使用描述性流行病学来解释伤亡负担 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。 在文献中使用了来自17个州向国家暴力死亡报告系统报告的数据 (NVDRS)2014-2018年。NVDRS包含600多个与死者、肇事者、犯罪有关的变量 场景，以及法医检查，包括法医和执法人员的叙述。有了这些数据，我们 建议审查家庭和环境特征(例如，亲密伴侣暴力、经济状况 压力、健康问题、滥用药物、帮派活动)与枪支有关的美国儿童死亡事件，以及 使用差异和不相称性的测量来确定这些因素如何因种族/民族而变化。 此外，我们将采用混合方法，阐明#年与枪支有关的死亡情况。 0-17岁的美国儿童故意(例如，杀人、自杀、无意)。与枪支有关的死亡人数将是 使用《国际疾病分类》第10版(ICD-10)和损伤的外部原因确定 密码。未使用ICD-10和电子代码捕获的病例将使用其他变量进行识别 在NVDRS内实施(例如，直接死因、根本死因)。定性的 对法医和执法叙述的分析将确定独特的主题并提供背景 到用定量方法刻画的关系。为了评估我们结果的概括性， 敏感度分析将用于比较17个州和50个州的拟议研究结果 NVDRS表示将于2018年提交报告。这项研究的长期目标是为 儿科枪击死亡，可为今后在研究、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.