415 - Emergency department discharges for firearm injury in the Vizient Clinical Data Base, 2019 to 2024

Publication Number: 415.4882

Alyssa Harris, Vizient, Inc, Hinsdale, IL, United States; Hannah R. Murphy, Vizient Inc., East Rochester, NY, United States; Madeleine C. McDowell, vizient, Carbondale, CO, United States

Background: Firearm injuries are the leading cause of death among U.S. children and teens, representing a critical public health issue. Post-COVID-19 data show that firearm-related ED visits among children more than doubled, with the highest increases seen in females, ages 10-14, Hispanic, and Black youth. This study uses the Vizient Vulnerability Index™ to assess how socioeconomic and demographic factors contribute to these disparities.

Objective: To describe trends and disparities in firearm injuries among youth ED discharges by age, demographics, and vulnerability.

Design/Methods: We analyzed ED discharges for ages 0-19 from January 2019 to June 2024 using the Vizient Clinical Data Base (age groups: 0-4, 5-9, 10-14, 15-19 years). Of 32,157,968 ED visits, 19,721 were for initial firearm injuries, identified through ICD-10-CM codes, with comorbid mental health and social determinant codes included. The Vizient Vulnerability Index™ was applied at the zip code level to assess patient vulnerability.

Results: Firearm injury rates in the ED were 6.2, 16.3, 53.0, and 162.4 per 100,000 ED discharges for the 0-4, 5-9, 10-14, and 15-19-year age groups, respectively. Rates peaked in Q2-2022 at 300.7 per 100,000 for 15-19-year-olds. Black adolescents accounted for 71.9% of firearm injuries, while White adolescents comprised only 24.8%, reversing the proportions seen in non-firearm cases. Medicaid recipients and individuals from high-vulnerability zip codes were overrepresented in firearm cases across all age groups. A predictive model found increased odds of firearm injury ED visits for Black youth (OR 3.44), Hispanic youth (OR 1.40), those with substance use disorders (OR 1.31), and residents of high-vulnerability areas (OR 4.08). The absence of child access prevention laws was also associated with higher firearm injury rates (OR 1.52).

Conclusion(s): This study highlights disparities in youth firearm injury encounters, most prevalent among Black and Hispanic youth, Medicaid recipients, and those in high-vulnerability areas. Factors like substance use disorders and the lack of child access prevention laws further compound this risk. Addressing these disparities requires interventions, such as socioeconomic supports, violence prevention programs, and policy changes, including child access prevention laws. Future research should explore how social determinants intersect with firearm injury risk to inform more equitable public health strategies.