In an article being early released this week in Pediatrics, Dr. Craig Newgard of the Oregon Health & Science University and colleagues from across the country examined national trends, geographic locations of pediatric firearm events, and geospatial changes over time, with particular attention to spatial clustering of events (known as “hotspots”) (10.1542/peds.2024-068179).
For this cross-sectional study, the authors used a national 911 emergency medical system (EMS) database, called NEMSIS (National EMS Information Systems). Data from over a decade (1/1/2012–12//31/2022) of 911 calls from all 50 states, including transports, non-transports, and deaths at the scene for children (0–10 years) and adolescents (11–17 years) were included; 37 states had continuous data that could be analyzed for clustering changes over time.
The main outcome was firearm injury; intent was characterized (when available) as assault, self-inflicted, unintentional, or other. Zip code (first for the incident site and secondarily for home location), was used to map locations of all pediatric firearm injury calls, with a focus on identifying areas with high numbers.
Logically, clusters or “hotspots” represent areas that could benefit most from community-based “upstream” interventions, such as built environment improvements, added greenspace, safer public transportation, and peace-keeper organizations.
The data speak for themselves and are displayed both in graphic and narrative form for readers—watch the authors’ video abstract for a great introduction.
In short, as compared to children, more adolescents:
► suffered firearm injuries (representing 85.9% of the total),
► were assaulted (56.9% versus 43.8%, respectively) as the identified intent, and
► were injured in a hotspot area (51.5% versus 40.5%, respectively).
Firearm clusters, as compared to areas without clustering, were more likely to be or have:
► urban areas with greater racial and ethnic diversity,
► lower Child Opportunity Index and higher Social Vulnerability Index, and
► lower educational levels and worse socioeconomic indicators.
Rates of firearm injuries were highest in the South and Midwest US, with increasing numbers of new zip codes identified as hotspots in 2022 for both children (213 [47.8%]) and adolescents (148 [32.1%]). We need new data gathered in a thoughtful and meaningful way, as Dr. Craig Newgard and colleagues have done here, to pave the way for changes that can reduce pediatric firearm injuries.
Courageous legislators and policymakers are essential to combatting the public health epidemic of pediatric gun violence. Restrictive firearm policies, including background checks, minimum age, waiting periods, child access, and avoidance of stand-your-ground and concealed carry laws are associated with reductions in firearm mortality rates in rigorous recent studies. Each of us has a critical role here too, not only in legislative advocacy, but in our day-to-day work with families.
Find out more about the AAP’s “Connected Kids: Safe, Strong, Secure” initiative here, and the AAP’s policies and recommendations about gun safety here. Whether you do or do not own a gun is irrelevant—we all need to work together to reduce firearm injuries in children and adolescents. None of us can do this alone!
