Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis School of Medicine, United States of America; University of California Firearm Violence Research Center, United States of America.
Violence Prevention Research Program, Department of Emergency Medicine, University of California Davis School of Medicine, United States of America; University of California Firearm Violence Research Center, United States of America.
Prev Med. 2020 Oct;139:106198. doi: 10.1016/j.ypmed.2020.106198. Epub 2020 Jul 9.
Individuals with a firearm injury are at high risk of subsequent firearm victimization, but characteristics associated with sustaining recurrent firearm injuries are not well understood. In this retrospective cohort study, we sought to quantify the hazards of sustaining subsequent assaultive firearm injuries among people with an initial firearm assault injury and to identify characteristics associated with recurrent victimization. Using hospital discharge, emergency department, and mortality records, we identified and followed all individuals aged ≥15 years with a nonfatal firearm assault injury resulting in an emergency department visit or hospital admission in California, 2005-2013. We model transitions from one injury to the next and from injury to death, accounting for event history, covariates, and competing risks using multistate models. 29,156 people had an index nonfatal firearm assault injury. Among individuals with 1 such injury, 3.1% had additional nonfatal firearm assault injuries and 1.0% subsequently died from firearm homicide. Among individuals with 2+ nonfatal firearm assaults, 2.0% died from firearm homicide. The estimated transition probability for 1 to 2+ nonfatal injuries reached 10% by 8.5 years post-index injury. The rate of subsequent nonfatal firearm assault injury was highest among men (hazard ratio [HR]: 3.87; 95% confidence interval [CI]: 2.63-5.69) and Blacks (vs. whites) (HR: 2.69; 95% CI: 1.99-3.64). Identification of additional risk markers will require more detailed individual-level data; nonetheless, this study supports the generalizability of findings from smaller studies, provides broad guidance for allocating scarce resources, and suggests that interventions on root causes of violence disparities may have downstream effects on recurrence.
个体因枪支伤害而处于后续枪支伤害的高风险之中，但与持续遭受反复枪支伤害相关的特征尚未得到很好的理解。在这项回顾性队列研究中，我们试图量化首次遭受枪支攻击伤害的人群中后续遭受攻击性枪支伤害的风险，并确定与再次受害相关的特征。我们利用医院出院、急诊和死亡记录，识别并随访了加利福尼亚州所有年龄≥15 岁的非致命性枪支攻击伤害患者，这些患者因急诊就诊或住院而接受了治疗。我们使用多状态模型，通过事件历史、协变量和竞争风险来模拟从一次伤害到下一次伤害以及从伤害到死亡的转移。29156 人患有指数性非致命性枪支攻击伤害。在患有 1 次此类伤害的个体中，3.1%有其他非致命性枪支攻击伤害，1.0%随后死于枪支凶杀。在患有 2 次及以上非致命性枪支伤害的个体中，2.0%死于枪支凶杀。在指数性伤害后 8.5 年内，1 次伤害进展为 2 次及以上非致命性伤害的估计转移概率达到 10%。后续非致命性枪支攻击伤害的发生率在男性（风险比[HR]：3.87；95%置信区间[CI]：2.63-5.69）和黑人（与白人相比）（HR：2.69；95% CI：1.99-3.64）中最高。确定其他风险标志物将需要更详细的个体层面数据；尽管如此，本研究支持了来自较小研究的发现的可推广性，为稀缺资源的分配提供了广泛的指导，并表明针对暴力差异根源的干预措施可能会对复发产生下游影响。
