PM1057: Racial and Ethnic Disparities in Pediatric Firearm Injuries Presenting to United States Emergency Departments

Background: Firearm injuries are a leading cause of morbidity and mortality among US children, and a detailed understanding of sociodemographic risk factors can guide preventative strategies. However, race and ethnicity data were previously missing from nationally representative Emergency Department (ED) surveys. The magnitude of racial/ethnic disparities for pediatric firearm injuries based on recent epidemiological data is unknown.

Methods: We performed a retrospective cross-sectional analysis of pediatric patients ( < 18 years old) presenting with firearm injuries using the 2019 Nationwide Emergency Department Survey (NEDS), the largest all-payor ED survey in the US that contains data from 989 hospitals. Our primary outcome was firearm injury intent, defined using previously established ICD-10 codes and intent classifications: assault, accidental, self-harm, and undetermined. Separate multivariable logistic regressions were used to measure the association between race/ethnicity and firearm injury intent. Secondary outcomes included mortality and ED disposition (treated at the index hospital vs. transferred to another facility). Race/ethnicity was categorized as Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Hispanic/Latino (HL), and other. NHW was utilized as the comparison group in all models. Covariates included age, sex, insurance, rurality, and zip-code-based median household income.

Results: Of 6,837 weighted ED visits for pediatric firearm injuries, most patients were male (85%), publicly insured (66%), and living in the lowest quartile for median household income (54%). NHB patients made up the largest percentage of assault (64%), accidental (47%), and undetermined (56%) intent victims, whereas NHW patients made up most self-harm intent victims (71%) (Figure). Racial/ethnic disparities persisted in all multivariable models (Table). Notably, when compared to NHW patients, higher adjusted odds of assault intent were demonstrated for NHB (aOR [95% CI]: 1.22 [1.15, 1.30], p< 0.001), HL (aOR [95% CI]: 1.18 [1.09, 1.27], p< 0.001), and other race/ethnicity (aOR [95% CI]: 1.17 [1.05, 1.29], p=0.003) patients. Lower adjusted odds of self-harm intent were seen for NHB (0.95 [0.92, 0.97], p< 0.001) and HL patients (aOR [95% CI]: 0.95 [0.92, 0.98], p< 0.001). Overall, HL patients had a decreased adjusted odds of mortality (aOR [95% CI]: 0.96 [0.92, 1.00], p=0.03) and an increased adjusted odds of transfer (aOR [95% CI]: 1.10 [1.04, 1.17], p=0.001), but no significant differences in the adjusted odds of mortality or transfer were demonstrated for NHB and other race/ethnicity patients.

Conclusion: Racial and ethnic disparities persist in pediatric firearm injuries even after controlling for known sociodemographic risk factors, suggesting that unmeasured social determinants of health are uniquely affecting racial and ethnic groups and contributing to their unequal burdens of firearm morbidity and mortality. These updated epidemiological data can be used to tailor interventions for high-risk groups.