Tashiro Jun, Lane Rebecca S, Blass Lawrence W, Perez Eduardo A, Sola Juan E
From the Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
J Trauma Acute Care Surg. 2016 Oct;81(4 Suppl 1):S54-60. doi: 10.1097/TA.0000000000001177.
Gun control laws vary greatly between states within the United States. We hypothesized that states with strict gun laws have lower mortality and resource utilization rates from pediatric firearms-related injury admissions.
Kids' Inpatient Database (1997-2012) was searched for accidental (E922), self-inflicted (E955), assault (E965), legal intervention-related (E970), or undetermined circumstance (E985) firearm injuries. Patients were younger than 20 years and admitted for their injuries. Case incidence trends were examined for the study period. Propensity score-matched analyses were performed using 38 covariates to compare outcomes between states with strict or lenient gun control laws.
Overall, 38,424 cases were identified, with an overall mortality of 7%. Firearm injuries were most commonly assault (64%), followed by accidental (25%), undetermined circumstance (7%), or self-inflicted (3%). A small minority involved military-grade weapons (0.2%). Most cases occurred in lenient gun control states (48%), followed by strict (47%) and neutral (6%).On 1:1 propensity score-matched analysis, in-hospital mortality by case was higher in lenient (7.5%) versus strict (6.5%) states, p = 0.013. Lenient states had a proportionally higher rate of accidental (31%) and self-inflicted injury (4%) versus strict states (17% and 1.6%, respectively), p < 0.001. Assault-related injuries were proportionally lower in lenient (54%) versus strict (75%) states, p < 0.001. Military-grade weapons were more common in lenient (0.4%) versus strict (0.1%) states, p = 0.001.
These findings highlight the importance of legislative measures and their role in injury prevention, as firearm injuries are entirely avoidable mechanisms of injury. Lenient gun control contributes not only to worse outcomes per case, but also to a more significant and detrimental impact on public health.
Epidemiologic study, level III.
美国各州的枪支管制法律差异很大。我们假设，拥有严格枪支法律的州，因儿童枪支相关伤害入院的死亡率和资源利用率较低。
在儿童住院数据库（1997 - 2012年）中搜索意外（E922）、自残（E955）、袭击（E965）、法律干预相关（E970）或情况不明（E985）的枪支伤害。患者年龄小于20岁，因伤入院。研究了研究期间的病例发病率趋势。使用38个协变量进行倾向评分匹配分析，以比较枪支管制法律严格或宽松的州之间的结果。
总体而言，共识别出38424例病例，总体死亡率为7%。枪支伤害最常见的是袭击（64%），其次是意外（25%）、情况不明（7%）或自残（3%）。少数涉及军事级武器（0.2%）。大多数病例发生在枪支管制宽松的州（48%），其次是严格的州（47%）和中立的州（6%）。在1:1倾向评分匹配分析中，病例的院内死亡率在宽松州（7.5%）高于严格州（6.5%），p = 0.013。与严格州相比，宽松州意外伤害（31%）和自残伤害（4%）的比例更高（严格州分别为17%和1.6%），p < 0.001。与袭击相关的伤害在宽松州（54%）的比例低于严格州（75%），p < 0.001。军事级武器在宽松州（0.4%）比严格州（0.1%）更常见，p = 0.001。
这些发现凸显了立法措施的重要性及其在预防伤害中的作用，因为枪支伤害是完全可以避免的伤害机制。宽松的枪支管制不仅导致每例病例的结果更差，而且对公众健康产生更重大和有害的影响。
流行病学研究，三级。
