Smith Randi N, Williams Keneeshia N, Roach Robert M, Tracy Brett M
1371 Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Division of Acute Care Surgery, Grady Memorial Hospital, Atlanta, GA, USA.
Am Surg. 2020 Sep;86(9):1067-1072. doi: 10.1177/0003134820942194. Epub 2020 Aug 11.
Food insecurity (FI), defined as inadequate access to affordable and quality nutrition, has negative health consequences. FI and violence share similar root causes. The aim of this study was to determine the association of FI with gunshot injury (GSI) incidence.
We performed a retrospective review of all patients from 2012 to 2018 who sustained a GSI. Food access data was abstracted from the US Department of Agriculture. We analyzed the impact of FI, low food access (LA), and low food access with no vehicle (LANV) on the incidence of GSI using Poisson regression. We also compared high-risk zip codes for GSI, FI, LA, and LANV using geospatial analysis.
There were 1700 patients in our cohort from 33 different zip codes. The median incidence of GSI per zip code was 142 (85-164); 5 zip codes comprised 50% of all GSI events. FI (incidence rate ratio [IRR] 4.05, 95% CI 3.98-4.13, < .0001), LA (IRR 2.97, 95% CI 2.92-3.03. < .0001), and LANV (IRR 2.58, 95% CI 2.55-2.62, < .0001) were significant predictors of GSI incidence. The FI model was superior to the LA and LANV models. Geospatial analysis demonstrated that both FI ( < .0001) and LANV ( < .0001) were significantly associated with GSI, while LA was not ( > .05).
FI is an independent risk factor for GSI incidence. Additionally, a majority of GSI events occur in a minority of communities. These data provide a novel opportunity for social services to guide future violence prevention strategies.
粮食不安全（FI）被定义为难以获得负担得起的优质营养，会对健康产生负面影响。粮食不安全和暴力有着相似的根源。本研究的目的是确定粮食不安全与枪伤（GSI）发生率之间的关联。
我们对2012年至2018年期间所有遭受枪伤的患者进行了回顾性研究。粮食获取数据摘自美国农业部。我们使用泊松回归分析了粮食不安全、低粮食获取（LA）和无车辆情况下的低粮食获取（LANV）对枪伤发生率的影响。我们还使用地理空间分析比较了枪伤、粮食不安全、低粮食获取和无车辆情况下的低粮食获取的高风险邮政编码区域。
我们的队列中有来自33个不同邮政编码区域的1700名患者。每个邮政编码区域的枪伤发生率中位数为142（85 - 164）；5个邮政编码区域占所有枪伤事件的50%。粮食不安全（发病率比值比[IRR] 4.05，95%置信区间3.98 - 4.13，P <.0001）、低粮食获取（IRR 2.97，95%置信区间2.92 - 3.03，P <.0001）和无车辆情况下的低粮食获取（IRR 2.58，95%置信区间2.55 - 2.62，P <.0001）是枪伤发生率的显著预测因素。粮食不安全模型优于低粮食获取和无车辆情况下的低粮食获取模型。地理空间分析表明，粮食不安全（P <.0001）和无车辆情况下的低粮食获取（P <.0001）均与枪伤显著相关，而低粮食获取则不然（P >.05）。
粮食不安全是枪伤发生率的独立危险因素。此外，大多数枪伤事件发生在少数社区。这些数据为社会服务指导未来的暴力预防策略提供了新的契机。
