Authors say studies point to the need for more research on root causes of urban violence

PHILADELPHIA -- Deaths and injuries from gun violence occur at higher rates in the United States compared to other developed countries. Yet, there has been relatively little public health research aimed at understanding and preventing this important threat to health. In a Viewpoint published this week in JAMA Surgery, researchers from the Perelman School of Medicine at the University of Pennsylvania, argue for more research on firearm injury, including the establishment of a national database on incidents of gun violence. The authors point to recent research showing that in Philadelphia, gun murders and injuries are much more strongly associated with race than neighborhood income levels.

"Firearm violence is still largely a taboo research subject," said lead author Jessica Beard, MD, MPH, a postdoctoral fellow in the department of Traumatology, Surgical Critical Care, and Emergency Surgery at Penn Medicine. "We struggle to obtain even basic information on its epidemiology. We need data to accurately assess the overall extent and geographic distribution of this problem."

As trauma surgeons in Philadelphia, Beard and co-author Carrie A. Sims, MD, MS, an associate professor of Traumatology, Surgical Critical Care, and Emergency Surgery, routinely treat victims of gun violence in the city. Although they acknowledge that perfecting the clinical management of gunshot wound patients is important, they believe that the best way to address this public health problem is to prevent it.

"When we save a patient in the operating room, we feel great, and yet despite our hard work the patients keep coming," Sims said. "Sometimes we feel powerless to address the deeper causes of this problem."

With colleagues from the Penn Injury Science Center, Beard and Sims have been researching the epidemiology of gun violence in Philadelphia. In a study published in the March issue of the American Journal of Public Health, the Penn team analyzed statistics on firearm assaults in Philadelphia during 2013-14. Results showed that the gun murders and injuries were much more strongly associated with race than with neighborhood income levels. People living in relatively high-income black neighborhoods, for example, suffered a rate of firearm assault almost 16 times higher than that experienced by people living in white neighborhoods with the same income.

According to police data analyzed by the researchers, more than 80 percent of victims of firearm injuries reported in Philadelphia were black, and less than 6 percent were non-Hispanic whites.

"This racial/ethnic disparity is the 'elephant in the room' of firearm injury epidemiology," Beard said. In the new essay, she and Sims argue for more research and scientific resources to explain this disparity, which they suggest may be rooted in structural inequality and other social factors that are amenable to policy interventions.

"We as trauma surgeons need to work with our surgical associations and members of government to advocate for more research funding to determine the root causes of this important public health problem--and to start identifying effective prevention strategies," Beard said.

In a 2013 "Statement on Firearm Injuries," the American College of Surgeons called for a national database on these injuries--which would allow researchers to track trends and determine if interventions are working. Beard and Sims echo this recommendation, saying that such a database would be a basic first step towards understanding and addressing the problem of urban gun violence in America.

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Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $5.3 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 18 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $373 million awarded in the 2015 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center -- which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report -- Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2015, Penn Medicine provided $253.3 million to benefit our community.