Understanding the epidemiology of firearm injuries in a large urban county: a guide for targeted intervention efforts

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ABSTRACT Firearm violence is a major public health problem in the United States (US), and firearm-related mortality far surpasses that in every other country in the world. The goal of this project is to understand the epidemiology of firearm injuries and deaths in a large and diverse population center (Harris County, Texas) in order to identify trends and risk factors to inform prevention efforts. We propose a 3-year retrospective review of data on children and adults who were injured or killed by firearms in Harris County to examine the scope of firearm violence and define risk factors to target future intervention efforts. In order to capture data on the maximum number of affected individuals, an integrated database for contemporary firearm violence that includes non-fatal and fatal events from trauma centers, medical examiner's office and police records will be developed. The integrated database will include personal, social, socioeconomic, and environmental variables about the shooting victims based on a social-ecological model for firearm violence prevention. This will be used to identify and categorize individual-level and neighborhood-level geographic, demographic, temporal, social, and socioeconomic risk factors for firearm-related violence. Geostatistical models will be used to identify neighborhood-level socioeconomic predictors based on victim residence. Finally, firearm violence “hot spots” will be characterized based on official crime data for firearm-related incidents (both injury and non-injury) using spatial clustering by geographic unit analysis. Understanding which subpopulations are being injured or killed, what the shooting context was, and where the incidents occurred will provide a wealth of data to devise strategic interventions for decreasing firearm violence at the local level. The integration of firearm violence data from multiple data sources in a large and diverse population center will provide a unique platform to analyze injury clusters and provide evidence-based prioritization of risk factors to help communities design targeted interventions.