儿童接触预防法的变异性与儿童 firearm 伤害。
Variability of child access prevention laws and pediatric firearm injuries.
机构信息
From the Department of Pediatric Surgery (E.C.H., C.S.C., K.P.L., M.T.A.), Center for Surgical Trials and Evidence-Based Practice (E.C.H., K.P.L, M.T.A.), Department of Cardiothoracic and Vascular Surgery (C.C.M.), McGovern Medical School at The University of Texas Health Science Center at Houston; Children's Memorial Hermann Hospital (C.S.C., K.P.L., M.T.A.); and Department of Surgical Oncology (M.T.A.), The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
出版信息
J Trauma Acute Care Surg. 2018 Apr;84(4):613-619. doi: 10.1097/TA.0000000000001786.
BACKGROUND
State-level child access prevention (CAP) laws impose criminal liability on adults who negligently allow children access to firearms. The CAP laws can be further divided into strong CAP laws which impose criminal liability for negligently stored firearms and weak CAP laws that prohibit adults from intentionally, knowingly, and/or recklessly providing firearms to a minor. We hypothesized that strong CAP laws would be associated with a greater reduction in pediatric firearm injuries than weak CAP laws.
METHODS
We constructed a cross-sectional national study using the Healthcare Cost and Utilization Project-Kids Inpatient Database from 2006 and 2009 using weighted counts of firearm-related admissions among children younger than 18 years. Poisson regression was used to estimate the association of CAP laws with pediatric firearm injuries.
RESULTS
After adjusting for race, sex, age, and socioeconomic income quartile, strong CAP laws were associated with a significant reduction in all (incidence rate ratio, 0.70; 95% confidence interval, 0.52-0.93), self-inflicted (incidence rate ratio, 0.46; 95% confidence interval, 0.26-0.79), and unintentional (incidence rate ratio, 0.56; 95% confidence interval, 0.43-0.74) pediatric firearm injuries. Weak CAP laws, which only impose liability for reckless endangerment, were associated with an increased risk of all pediatric firearm injuries.
CONCLUSION
The association of CAP laws on hospitalizations for pediatric firearm injuries differed greatly depending on whether a state had adopted a strong CAP law or a weak CAP law. Implementation of strong CAP laws by each state, which require safe storage of firearms, has the potential to significantly reduce pediatric firearm injuries.
LEVEL OF EVIDENCE
Prognostic and epidemiology study, level III.
背景
州级儿童接触预防 (CAP) 法规定，疏忽导致儿童接触枪支的成年人应承担刑事责任。CAP 法可进一步分为严格的 CAP 法，该法规定因疏忽而存放枪支应承担刑事责任，以及薄弱的 CAP 法，该法禁止成年人故意、明知或鲁莽地向未成年人提供枪支。我们假设严格的 CAP 法与减少儿科枪支伤害的关系比薄弱的 CAP 法更密切。
方法
我们使用医疗保健成本和利用项目儿童住院数据库，构建了一项 2006 年至 2009 年的全国性横断面研究，使用加权计数法计算了 18 岁以下儿童因枪支相关住院的人数。泊松回归用于估计 CAP 法与儿科枪支伤害的关联。
结果
在调整种族、性别、年龄和社会经济收入四分位数后，严格的 CAP 法与所有（发病率比，0.70；95%置信区间，0.52-0.93）、自我伤害（发病率比，0.46；95%置信区间，0.26-0.79）和非故意（发病率比，0.56；95%置信区间，0.43-0.74）儿科枪支伤害均显著相关。仅对鲁莽危害行为追究责任的薄弱 CAP 法与所有儿科枪支伤害的风险增加相关。
结论
根据各州是否通过严格的 CAP 法或薄弱的 CAP 法，CAP 法对儿科枪支伤害住院率的影响有很大差异。各州实施严格的 CAP 法，要求枪支安全存放，有可能显著减少儿科枪支伤害。
证据水平
预后和流行病学研究，III 级。
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