Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
J Surg Res. 2020 Nov;255:612-618. doi: 10.1016/j.jss.2020.06.004. Epub 2020 Jul 10.
United States state-level firearm legislation is linked to rates of firearm-related suicides, pediatric injuries, nonfatal injuries, hospital discharges, and mortality. Our objective was to evaluate the burden of firearm-related injuries requiring surgery for states with strict as opposed to nonstrict firearm legislation.
The 2014 Healthcare Cost and Utilization Project State Inpatient Database was utilized to extract data for all available 28 states and the District of Columbia. States were dichotomized into strict and nonstrict legislative categories using the 2014 Brady and Gifford's scores (15 strict, 14 nonstrict). Patients with a firearm injury requiring surgery were identified and the incidence of surgery aggregated to the county level. Negative binomial regression with an offset for county-level residential population was used to estimate the incident rate ratio for surgical volume comparing counties in strict and nonstrict states. Models were stratified by injury intent and adjusted for county population characteristics.
A total of 11,939 patients were hospitalized with firearm-related injuries, with 65% (n = 7759) undergoing an operative procedure. The adjusted incidence rate of firearm-related surgery per 100,000 people was 1.29 (95% confidence interval; 1.13-1.46, P < 0.001) times higher and the adjusted cost of hospitalization per 100,000 people was $6028.69 ($3744.61-$8312.78, P = 0.001) greater for counties in nonstrict states than those for counties in strict states. The burden of health care for these injuries is invariably shifted to state- and county-level finances.
The rate of firearm-related surgical intervention was higher for states with nonstrict firearm legislation than that for states with strict legislation. States should reevaluate their firearm legislation to potentially reduce the burden of firearm-related surgery and health care costs.
美国州级枪支立法与枪支相关自杀率、儿童伤害、非致命伤害、住院出院和死亡率有关。我们的目的是评估与枪支有关的需要手术的伤害负担，这些伤害发生在枪支立法严格的州和枪支立法不严格的州。
利用 2014 年医疗保健成本和利用项目州立住院数据库提取所有 28 个州和哥伦比亚特区的数据。使用 2014 年布雷迪和吉福德分数将各州分为严格和不严格的立法类别（15 个严格，14 个不严格）。确定需要手术治疗的枪支伤害患者，并将手术量汇总到县一级。使用带有县居民人口偏移量的负二项式回归估计手术量的手术率比，比较严格和不严格州的县。模型按伤害意图分层，并根据县人口特征进行调整。
共有 11939 名患者因枪支相关伤害住院治疗，其中 65%（n=7759）接受了手术。每 10 万人中枪支相关手术的调整发病率为 1.29（95%置信区间：1.13-1.46，P<0.001）倍，每 10 万人中住院治疗的调整费用为 6028.69 美元（3744.61-8312.78，P=0.001），非严格州的县高于严格州的县。这些伤害的医疗保健负担不可避免地转移到州和县一级的财政上。
枪支立法不严格的州与枪支立法严格的州相比，与枪支有关的手术干预率更高。各州应重新评估其枪支立法，以降低与枪支有关的手术和医疗保健费用的负担。
