O0489 Oct.4: 4:40pm - County-Level Poverty and Disparities in Firearm-Related Mortality in U.S. Youth 5-24 Years Old

Background: Youth firearm deaths are a growing public health crisis in the U.S. The relationship between neighborhood poverty, a known risk factor for negative youth health outcomes, and the risk of firearm fatalities, is unknown.

Objective: To examine the association between county-level poverty and firearm-related fatalities in U.S. youth 5-24 years old.

Design/

Methods: Firearm fatalities in the U.S. were analyzed from 2007-2016 using the Centers for Disease Control Compressed Mortality File. County demographics and poverty levels were obtained from the U.S. Census Bureau. We calculated annual rates per 100,000 youth 5- 24 years old. We estimated a set of multivariable negative binomial regression models with firearm death (total, homicide, suicide, and unintentional) as the dependent variable and poverty concentration (0-4.9%, 5-9.9%, 10-14.9%, 15-19.9%, and >20% living below the federal poverty level) as the independent variable, controlling for demographics of the fatalities (age, sex, race/ethnicity), county urbanicity, and estimated state-wide gun prevalence. Effects were expressed as incidence rate ratios (IRRs). We calculated the population attributable fraction (PAF: percent and number of deaths that would not have occurred if exposure risk was that of the lowest poverty counties) and years of potential life lost for each intent.

Results: There were 67,905 firearm fatalities among youth 5-24 years old from 2007-2016 (62.6% homicides, 33.9% suicides, 2.4% unintentional). Overall firearm homicide rate was 8.5/100,000 youth in 2007 and 9.2/100,000 youth in 2016. In our multivariable model, risk for firearm mortality increased in a stepwise manner with poverty level (Figure 1). Compared with counties in the lowest poverty level, counties with the highest poverty level had an increased risk of firearm deaths from all intents (IRR 2.29, 95% CI 1.96, 2.67), homicide (IRR 3.57, 95% CI 2.81, 4.54), suicide (IRR 1.45, 95% CI 1.2, 1.76) and unintentional deaths (IRR 9.3, 95% CI 2.31, 37.3). This disparity was observed in each of the 10 years and was more pronounced in total-firearm and homicide mortality (Figure 2). The PAF was 51% for total firearm deaths, 66% for homicide, 30% for suicide, and 86% for unintentional intent. This translates to 34,292 firearm deaths that would have been prevented if all counties had the lowest poverty level, including 27,932 homicides, 6,910 suicides, and 1,404 unintentional deaths. In total, there were 3,833,105 years of potential life lost.

Conclusion: Marked disparities in firearm mortality rates among youth are associated with county poverty level. Over half of firearm deaths are potentially attributable to concentrated county poverty, suggesting efforts to curb youth firearm fatalities should focus on high poverty areas.