Association of Race,Ethnicity,and Outcomes Following Pediatric Firearm Injury: A United States Population Study

Abstract

Purpose

As of 2019, firearm injury is the leading cause of death among children and adolescents. This study aims to investigate the association of race and ethnicity on the outcomes of pediatric firearm injury patients.

Methods

Firearm injuries among patients ages 0–17 years in 2016 and 2019 were identified using the Kids’ Inpatient Database, the largest database for the United States inpatient pediatric population representing 70–80% of all pediatric hospitalizations nationwide. Race and ethnicity were the primary independent variables, and the primary outcome was a composite variable of in-hospital morbidities, including outcomes such as postoperative infection, iatrogenic hypotension, and postoperative aspiration pneumonia. All outcomes except for length of stay were analyzed using multivariable logistic regression. Fine-Gray competing risks regression was used to analyze hospital length of stay. Subgroup analyses of patients under 15 years old, ZIP codes below median household income, urban counties, high severity injury, and each injury intent were used to identify effect modification.

Results

Among the 6173 firearm injury patients, no association was found between race and ethnicity and composite morbidity. Compared to non-Hispanic White patients, Black patients had decreased odds of inpatient mortality overall (OR 0.53 [95% CI 0.35-0.8], p = 0.003), although this association was not found in subgroups specific to assault, self-harm, populations >250,000, or age under 15 years. Overall, non-routine disposition and length of stay were not associated with race and ethnicity.

Conclusions

Race and ethnicity are not associated with morbidity following firearm injury in younger pediatric patients. Intent of injury, young age, and urban environment may act as effect modifiers for firearm mortality. Policy interventions can limit disparities in outcomes by targeting suicide and assault in specific racial and ethnic groups.

Keywords

firearm injury pediatrics length of stay healthcare disparities

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