Research to be presented at American Academy of Pediatrics National Conference finds teens in urban areas more likely to be victims of firearm assault, while children in rural settings are more likely to experience accidental injuries

CHICAGO - Researchers examining pediatric firearm injuries found that the age a child is injured by a gun is closely related to where he or she lives: the city or the country.

The study abstract, "Hospitalizations for Firearm Injuries in Children and Adolescents in the US: Rural Versus Urban," will be presented Monday, Sept. 18, at the American Academy of Pediatrics National Conference & Exhibition in Chicago.

For the study, researchers analyzed the Kids' Inpatient Database to identify hospitalizations for injuries due to firearms in patients under age 20. A total of 21,843 hospitalizations from 2006, 2009, and 2012 were compared based on demographics, rural versus urban location, and the cause of the injury (assault, suicide attempt, accidental, or undetermined).

Researchers found that most of the pediatric firearm injuries resulting in hospitalization occurred among older teens (ages 15 to 19) and that those living in urban areas had the highest rate of hospitalization. However, among younger children (ages 5 to 14) the rate of hospitalization was higher in rural areas. Accidental firearm injuries were the most common cause of hospitalization across all age groups in urban or rural locations, except for 15- to 19-year-olds living in urban areas (for which firearm assaults were highest). Researchers also found that rates of hospitalization for firearm injuries due to suicide attempts were higher in rural areas compared to urban areas among older teens.

"Compared with other causes of death in the United States, there is a relative scarcity of research on understanding the epidemiology of firearm injuries, and this is particularly true for the pediatric population," said lead author Bradley Herrin, MD, a pediatrician at the Yale School of Medicine. "This study helps to build our understanding of the problem by providing more detailed data on hospitalizations for firearm injuries in different pediatric age groups in both urban and rural communities."

Firearm injuries are a leading cause of injury and death for children and adolescents in the United States. Prior research has identified male gender, non-white race, low median income and late adolescent age as risk factors for both fatal and non-fatal firearm injuries. However, previous studies have not examined the differences in rates of firearm injury hospitalizations between rural and urban areas by age group.

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Herrin will present the abstract, available below, on Monday, Sept.18, from 5:10 p.m. to 6 p.m. CT in McCormick Place West, Room S106.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.

The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www. aap. org .

Abstract Title: Hospitalizations for Firearm Injuries in Children and Adolescents in the US: Rural versus Urban

Background: Firearm injuries are a leading cause of injury and death for children and adolescents in the United States. Prior research has identified male gender, non-white race, low median income and late adolescent age as risk factors for sustaining both fatal and non-fatal firearm injuries. There are limited data comparing rural versus urban firearm injuries in children and adolescents. Therefore, the objective of this study was to determine how hospitalization rates due to firearm injuries differ between rural and urban settings, and to compare rates by cause and demographic variables. Methods: The Kids' Inpatient Database, the largest publicly-available, all-payer pediatric inpatient database, was used to identify hospitalizations due to firearm injuries in children and adolescents < 20 years of age using ICD-9 and external cause of injury codes. Aggregated data on hospitalizations from 2006, 2009, and 2012 were analyzed to compare firearm injuries by cause (assault, suicide attempt, accidental, and undetermined) and demographics. Urban-rural classification was based on the patient's county of residence as determined by the National Center for Health Statistics. Cases were weighted to obtain nationally representative estimates. Census estimates were used to calculate incidence per 100,000. Results: Overall, 21,843 hospitalizations due to firearm injuries were included in the study. The overall hospitalization rate was higher in urban areas than in rural areas (risk ratio [RR] = 1.95, 95% confidence interval [CI] 1.81-2.10). Rates were higher in urban areas for 15 to 19-year-olds (RR = 2.76, 95% CI 2.51-3.03), but lower in urban areas among 5 to 9-year-olds (RR = 0.67, 95% CI 0.51-0.88) and 10 to 14-year-olds (RR = 0.79, 95% CI 0.68-0.93). There was no significant difference in regional rates among 0 to 4-year-olds (RR = 0.91, 95% CI 0.63-1.32). Accidental firearm injuries were the leading cause of hospitalization across age groups in both urban and rural areas except among urban 15 to 19-year-olds. Rates for accidental injury were higher in rural areas among 5 to 9-year-olds (RR = 2.12, 95% CI 1.60-2.81) and 10 to 14-year-olds (RR = 2.27, 95% CI 1.91-2.70). The leading cause of hospitalization for urban 15 to 19-year-olds was firearm assaults. Hospitalization rates for suicide attempts were higher in rural areas among 15 to 19-year-olds (RR = 1.84, 95% CI 1.42-2.38). Conclusions: Pediatric firearm assault injuries resulting in hospitalization are highest among urban 15 to19-year-olds. However, for younger age groups, hospitalization rates are higher in rural versus urban areas, and accidental firearm injuries contribute to the majority of these hospitalizations. These findings suggest that a varied public health approach is needed to reduce firearm-related injuries in these different regions of the country.