411 - Band-Aids Don't Fix Bullet Holes: The Impact of State Legislation on Pediatric Firearm Injury Mortality 2010 through 2021

Publication Number: 411.3951

Deanna Jewell, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Amber V. McKenna, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States

Background: Firearm injuries are the leading cause of death in children. There is wide variation in state legislation on firearms. We evaluated the impact of the restrictiveness of state legislation and specific types of legislation on the pediatric firearm mortality rate.

Objective: This study can guide advocacy efforts to decrease pediatric firearm mortality rate.

Design/Methods: Data was obtained from the Centers for Disease Control and Prevention from 2010-2021 for children 0-18 years. Fatal firearm injuries per state were included and stratified by intent (homicide, suicide, and unintentional). State ranking for firearm legislation was obtained from the Giffords Law Center to Prevent Gun Violence; rankings were not produced in 2011. Of these state rankings, concealed carry and safe storage were analyzed with repeated measures mixed modeling to determine their impact on pediatric firearm mortality rates.

Results: From 2010-2021, there were 28,472 pediatric firearm injury deaths, classified as homicide(16,649), suicide(9,784), unintentional(1,321), or other(718). There was a significant correlation between total deaths per 100,000 population and state gun law ranking for each of the 11 years analyzed, ranging from Spearman’s Rho correlation of 0.39, p=0.005 in 2012 to Spearman’s Rho correlation of 0.69, p< 0.0001 in 2015. For concealed carry laws, states with no permit requirements had 5.72 deaths per 100,000, compared to 4.38 deaths per 100,000 with basic permit guidelines(p < 0.0001), and 2.19 deaths per 100,000 with strict permit guidelines(p < 0.0001). In states with stand-your-ground laws, there were 1.55 more deaths per 100,000 than in states without these laws (p=0.0004). States requiring the use of a gun lock had 3.42 deaths per 100,000, compared to 4.71 deaths per 100,000 in states with no safe storage laws (p=0.004). States with negligence-based child access prevention(CAP) laws had 0.98 fewer total deaths and 0.77 fewer suicides per 100,000(total deaths p=0.04, suicide p=0.0005). States requiring certain safety design features had 1.78 fewer deaths per 100,000 (p=0.0087).

Conclusion(s): Over a 12-year period, states with lenient firearm legislation had higher mortality. States with no permit requirements for concealed carrying have higher mortality as do states with stand-your-ground laws. States requiring the use of gun locks, with negligence-based CAP laws, and requiring safety design features on firearms all have lower pediatric firearm mortality.

Contract for PGY2 of PM&R Residency
1_81702_saved_contract_mckenna_-_71[2].pdf

Child Access Prevention Laws
This graph represents death rates in states with the three types of child access prevention laws, separated in columns by intent of injury (total, homicide, and suicide).