Kaufman Elinore, Holena Daniel N, Yang Wei P, Morrison Christopher N, Jacoby Sara F, Seamon Mark, Sims Carrie, Wiebe Douglas J, Beard Jessica H
Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Epidemiology, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia.
Trauma Surg Acute Care Open. 2019 Aug 12;4(1):e000316. doi: 10.1136/tsaco-2019-000316. eCollection 2019.
Firearm injury is a major public health burden in the USA. Absent a single, reliable data source, researchers have attempted to describe firearm injury epidemiology using trauma registry data. To understand the implications of this approach, we compared trends in firearm assault incidence and case-fatality in Philadelphia over 10 years from two sources: the Pennsylvania Trauma Outcomes Study (PTOS), Pennsylvania's state-mandated trauma registry, and the Philadelphia Police Department database (PPD) of firearm assaults.
We included PTOS firearm assault patients treated in Philadelphia County and PPD database firearm assault victims from 2005 to 2014. We calculated counts of fatal and non-fatal incidents using PTOS and PPD data. We used generalized linear models adjusted for seasonality to estimate temporal trends in firearm assault rates and case-fatality for both data sources and compared patient demographics and injury characteristics between the two.
A total of 6988 PTOS and 14 172 PPD subjects met the inclusion criteria. In both data sets, firearm assault rates decreased significantly during the study period (PTOS: 5.19 vs. 3.43 per 10 000 person-years, change/year: -0.21, 95% CI -0.26 to -0.16; PPD: 10.97 vs. 6.70 per 10 000 person-years, change/year: -0.53, 95% CI -0.62 to -0.44). PTOS mean case-fatality rate was 26.5% and decreased significantly (change/year: -0.41, 95% CI -0.78% to 0.04%). PPD mean case-fatality rate was 18.9% with no significant change over time (p=0.41).
Relative to PPD data, PTOS data underestimated firearm assault incidence and overestimated mortality. Trends in case-fatality rates were disparate across the two data sources. A true understanding of firearm injury in the USA requires comprehensive data collection on the incidence, nature, and severity of these injuries. As trauma registry data are by definition incomplete, combining data sources is essential. Local law enforcement data are an important potential source for studying city-level firearm injury.
Level III, epidemiological.
在美国，枪支伤害是一项重大的公共卫生负担。由于缺乏单一可靠的数据源，研究人员试图利用创伤登记数据来描述枪支伤害的流行病学情况。为了解这种方法的影响，我们比较了费城10年间两个数据源中枪支袭击的发病率和病死率趋势：宾夕法尼亚州强制要求的创伤登记处宾夕法尼亚创伤结果研究（PTOS）以及费城警察局的枪支袭击数据库（PPD）。
我们纳入了2005年至2014年在费城县接受治疗的PTOS枪支袭击患者以及PPD数据库中的枪支袭击受害者。我们使用PTOS和PPD数据计算了致命和非致命事件的数量。我们使用针对季节性进行调整的广义线性模型来估计两个数据源中枪支袭击率和病死率的时间趋势，并比较了两者之间的患者人口统计学特征和损伤特点。
共有6988名PTOS受试者和14172名PPD受试者符合纳入标准。在两个数据集中，研究期间枪支袭击率均显著下降（PTOS：每10000人年5.19例对3.43例，每年变化：-0.21，95%可信区间-0.26至-0.16；PPD：每10000人年10.97例对6.70例，每年变化：-0.53，95%可信区间-0.62至-0.44）。PTOS的平均病死率为26.5%，且显著下降（每年变化：-0.41，95%可信区间-0.78%至0.04%）。PPD的平均病死率为18.9%，随时间无显著变化（p=0.41）。
相对于PPD数据，PTOS数据低估了枪支袭击的发病率，高估了死亡率。两个数据源的病死率趋势存在差异。要真正了解美国的枪支伤害情况，需要全面收集这些伤害的发病率、性质和严重程度的数据。由于创伤登记数据从定义上来说是不完整的，因此整合数据源至关重要。地方执法数据是研究城市层面枪支伤害的重要潜在来源。
三级，流行病学研究。
