Rural Versus Urban Hospitalizations for Firearm Injuries in Children and Adolescents.

Abstract

: media-1vid110.1542/5789654953001PEDS-VA_2017-3318<b>Video Abstract</b> OBJECTIVES: Firearms are a leading cause of injury and death for children and adolescents in the United States. We examined how hospitalization rates for firearm injuries differ for rural and urban populations. The Kids' Inpatient Database was used to identify hospitalizations for firearm injuries in patients <20 years of age by using <i>International Classification of Diseases, Ninth Revision</i> external-cause-of-injury codes. Data from 2006, 2009, and 2012 were analyzed to compare demographics and intent (assault, self-inflicted, unintentional, and undetermined). Urban-rural classification was based on patients' county of residence. Rates were calculated by using weighted cases and US Census data. There were 21 581 hospitalizations for firearm injuries. The overall hospitalization rate was higher in urban versus rural areas (risk ratio [RR] = 1.95; 95% confidence interval [CI]: 1.81-2.10). Rates were highest for assaults in urban 15- to 19-year-olds (RR = 7.82; 95% CI: 6.48-9.44). Unintentional injuries were the leading cause of hospitalizations in younger age groups in all urban and rural locations. Rates for unintentional injuries were lower among urban versus rural 5- to 9-year-olds (RR = 0.47; 95% CI: 0.36-0.63) and 10- to 14-year-olds (RR = 0.44; 95% CI: 0.37-0.52). Hospitalizations for firearm assaults among urban 15- to 19-year-olds represent the highest injury rate. Notably, hospitalizations are lower for urban versus rural 5- to 9-year-olds and 10- to 14-year-olds, and unintentional firearm injuries are most common among these groups. Preventative public health approaches should address these differences in injury epidemiology.