Rural Versus Urban Hospitalizations for Firearm Injuries in Children and Adolescents

Abstract

OBJECTIVES: Firearms are a leading cause of injury and death for children and adolescents in the United States. We examined how hospitalization rates for firearm injuries differ for rural and urban populations. METHODS: The Kids’ Inpatient Database was used to identify hospitalizations for firearm injuries in patients <20 years of age by using International Classification of Diseases, Ninth Revision external-cause-of-injury codes. Data from 2006, 2009, and 2012 were analyzed to compare demographics and intent (assault, self-inflicted, unintentional, and undetermined). Urban-rural classification was based on patients' county of residence. Rates were calculated by using weighted cases and US Census data. RESULTS: There were 21 581 hospitalizations for firearm injuries. The overall hospitalization rate was higher in urban versus rural areas (risk ratio [RR] = 1.95; 95% confidence interval [CI]: 1.81–2.10). Rates were highest for assaults in urban 15- to 19-year-olds (RR = 7.82; 95% CI: 6.48–9.44). Unintentional injuries were the leading cause of hospitalizations in younger age groups in all urban and rural locations. Rates for unintentional injuries were lower among urban versus rural 5- to 9-year-olds (RR = 0.47; 95% CI: 0.36–0.63) and 10- to 14-year-olds (RR = 0.44; 95% CI: 0.37–0.52). CONCLUSIONS: Hospitalizations for firearm assaults among urban 15- to 19-year-olds represent the highest injury rate. Notably, hospitalizations are lower for urban versus rural 5- to 9-year-olds and 10- to 14-year-olds, and unintentional firearm injuries are most common among these groups. Preventative public health approaches should address these differences in injury epidemiology.