Maureen Salamon

November 08, 2017

ATLANTA — Over the past 2 decades, gunshot injuries have gotten steadily more severe in the United States, creating a public health burden due to lingering physical and psychological effects, according to new research.

Hospitalization data from 44 states, gathered from 1993 and 2014, indicate that the severity of firearm injuries increased by an average of 1.4% year-over-year, with no breaks in the upward trend, said investigator Yi Zuo, MPH, from the Boston University School of Medicine.

The research takes on special significance in the wake of recent mass shootings, including one on November 4 at a Texas church that killed 26 people, he said here at the American Public Health Association 2017 Annual Meeting.

But just because gun victims survive their injuries doesn't mean they have completely recovered, Zuo told Medscape Medical News.

"Nowadays, people are intrigued by deaths from guns; however, 70% of gunshot wounds are not fatal," he said.

"Our study found that those who survive live compromised lives," he added. "There have to be interventions or programs to help them recover from the gunshots, both physically and mentally."

Serious Open Fractures

The overall increase in firearm injury severity from year to year has been driven by a decline in minor injuries but an increase in serious open fractures, which are treated more effectively than in years past, and by more gunshot patients being treated and released from emergency departments and trauma centers.

The trend of worsening cases is likely a major contributor to the overall increase in healthcare costs, he added.

In their cross-sectional study, Zuo and his colleagues examined a nationwide inpatient sample of nationally representative hospital claims, and identified nearly 723,000 firearm injury hospitalizations during a 22-year period. Gunshot severity scores ranged from 0 to 75, with higher scores being assigned to head, chest, and multiple wounds, and lower scores being assigned to extremity and single wounds.

Demographic characteristics recorded included age group, race, ethnicity, insurance status, average neighborhood income, and patient comorbidities.

About 9 in 10 people with gun injuries that led to hospitalization were the result of assault, whether intentional or unintentional, whereas 9% were due to suicide attempts.

Physical and Mental Recovery

The burden of increasingly severe gunshot wounds was mostly borne by black males 16 to 45 years of age, who were likely to be insured through Medicaid and live in a low-income neighborhood.

In children younger than 16 years, gunshot wounds were less severe, "probably because they were typically shot by accident," Zuo reported.

Over the 2 decades, the upward trend in gunshot severity was similar in men and women, although about 88% of people admitted to the hospital because of firearm injuries were males, he pointed out.

The finding that suicide attempts account for a significant number of severe gunshot wounds that require hospitalization is interesting, said Karen Liller, PhD, from the University of South Florida in Tampa.

"If someone is going to commit suicide with a firearm, the chances of being successful are greatly elevated, compared with other problems related to guns, such as homicide," Dr Liller told Medscape Medical News.

Zuo, who emigrated from China 3 years ago, said he was struck by the number of gun casualties in the United States, and wanted to contribute to a greater understanding of the phenomenon.

There was not much gun violence where Zuo grew up, but "here in the United States, and in the neighborhood I live in, I can see people leading compromised lives," he said. "I feel a sense of responsibility to make the public aware that gun violence is a crucial topic and we need to focus more on it."

In future research, baseline characteristics should be assessed to determine which markers are more strongly associated with multiple hospitalizations for gunshot wounds than with single hospitalization, he said.

Mr Zuo and Dr Liller have disclosed no relevant financial relationships.

American Public Health Association (APHA) 2017 Annual Meeting: Abstract 3277.0. Presented November 6, 2017.

Follow Medscape on Twitter @Medscape and Maureen Salamon @maureensalamon

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