Pediatric Firearm-Related Hospital Encounters by Child Opportunity Index Level.

Abstract

Whether variables specific to children's neighborhood-level social determinants of health are associated with neighborhood incidence of pediatric firearm-related injury hospital encounters has not been assessed in any entire state. This study sought to determine the relationship between home zip code Childhood Opportunity Index (COI) and zip code incidence of pediatric firearm-related injury hospital encounters in 4 geographically representative states. This retrospective observational cohort study combined 2016-2021 discharge data from Florida, Maryland, New York, and Wisconsin with COI 3.0 zip code data. The primary exposure was zip code COI quintile. The primary outcome was zip code incidence of pediatric (ages 0-17 years) firearm-related injury hospital encounters. Hot spots of pediatric firearm-related injury hospital encounters were identified. Incidence rate ratios of pediatric firearm-related injury hospital encounters were compared by child home zip code COI quintile. There were 6896 pediatric firearm-related injury hospital encounters. A larger proportion of hot spots were among very low compared with very high COI zip codes (28.4% vs 5.5%, P < .001). The zip code incidence rate ratio of pediatric firearm-related injury hospital encounters incrementally decreased with each rising quintile of zip code COI in all 4 states. Unintentional injury accounted for the largest proportion of firearm-related injury for both very low COI zip codes (n = 2044/3600, 56.8%) and very high COI zip codes (n = 142/253, 56.1%). Incidence of pediatric firearm-related injury hospital encounters increased as child opportunity decreased. Unintentional injury accounted for the largest proportion of pediatric firearm-related injury hospital encounters across all COI quintiles.