Demographic and Geographic Trends in Gunshot Wound-Associated Orthopedic Injuries among Children, Adolescents, and Young Adults in New York State from 2016–2020

Abstract

Background: The purpose of this study was to investigate temporal trends in gunshot wound (GSW)-associated orthopedic injuries among children, adolescents, and young adults in New York State, and to determine the impact of the onset of the COVID-19 pandemic on the incidence of these injuries. Methods: The New York Statewide Planning and Research Cooperative System (SPARCS) inpatient database was reviewed to identify patients ≤ 21 years of age who presented to a hospital with GSW-associated injuries from January 2016 to December 2020. Patient diagnosis codes were cross-referenced with the list of the International Classification of Diseases Version 10 Clinical Modification (ICD-10-CM) codes for orthopedic injuries to determine the incidence of GSW-associated orthopedic injuries among this cohort. The number of cases was cross-referenced with New York State census population estimates to calculate incidence per million. The geographic incidence was plotted over a map of New York State with sub-division based on facility Zone Improvement Plan (ZIP) codes. Poisson regression was used to compare the injury incidence in 2020 (pandemic onset) versus the preceding years (pre-pandemic). Results: Between 2016 and 2020, there were 548 inpatient admissions for GSW-associated orthopedic injuries, representing an incidence of 5.6 cases per million. Injury incidence decreased from 2016 to 2019, with an increase in 2020 representing almost 28% of the total cases identified. There was a statistically significant difference in the incidence rate ratio for 2020 compared to 2016–2019 (p < 0.001). The majority of patients were male (94%), African–American (73%), and covered by either Medicare (49%) or Managed Care (47%). Most cases were clustered around large metropolitan areas with low incidence in suburban and rural regions of the state. Conclusions: There was a two-fold increase in the incidence of GSW-associated orthopedic injuries among patients ≤ 21 years old in New York State during the onset of the COVID-19 pandemic.