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Abstract

Introduction

Firearm-related injuries are a major public health concern in the United States, contributing to significant Emergency Department (ED) visits. Understanding the impact of neighborhood socioeconomic status (SES) on these injuries is crucial for prevention. The Area Deprivation Index (ADI) has traditionally been the gold standard for assessing neighborhood SES, while the Distressed Communities Index (DCI) is a newer alternative.

Objective

This study compares the predictive accuracy of the DCI and ADI in identifying ED visits due to firearm-related injuries using Maryland ED data (2019-2020).

Methods

This retrospective study analyzed firearm-related ED visits in Maryland from January 2019 to December 2020. Three logistic regression models were constructed: one using DCI, one using ADI (stratified into three deprivation levels), and one incorporating both indices. Covariates included age, sex, race, insurance, and comorbidities. Model performance was assessed using Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and Receiver Operating Characteristic (ROC) curves.

Results

Of the 2 392 813 injury-related ED visits, 2504 (0.1%) were firearm-related, predominantly affecting Black individuals (84.7%) and males (88.2%), with a mean age of 29.8 ± 9.9 years. The most deprived neighborhoods (per both indices) had the highest firearm injury incidence. The DCI-only model (AIC = 12 703.88) performed comparably to the ADI-only model (AIC = 12 748.6), with no significant improvement when combined.

Conclusion

DCI and ADI are comparable predictors of firearm-related ED visits.

Keywords

area deprivation index distressed communities index emergency department visits firearms injuries model performance

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Comparing the Distressed Communities Index and Area Deprivation Index in Predicting Firearm-Related Emergency Department Visits