Gomez David, Saunders Natasha, Greene Brittany, Santiago Robin, Ahmed Najma, Baxter Nancy N
Division of General Surgery (Gomez, Greene, Ahmed), Department of Surgery, University of Toronto; Division of General Surgery (Gomez, Ahmed), St. Michael's Hospital, Unity Health Toronto; Li Ka Shing Knowledge Institute (Gomez, Ahmed, Baxter), St. Michael's Hospital, Unity Health Toronto; ICES (Gomez, Saunders, Santiago, Baxter); Division of Pediatric Medicine (Saunders), The Hospital for Sick Children; Department of Pediatrics (Saunders), University of Toronto; Institute of Health Policy, Management and Evaluation (Saunders, Baxter), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia
Division of General Surgery (Gomez, Greene, Ahmed), Department of Surgery, University of Toronto; Division of General Surgery (Gomez, Ahmed), St. Michael's Hospital, Unity Health Toronto; Li Ka Shing Knowledge Institute (Gomez, Ahmed, Baxter), St. Michael's Hospital, Unity Health Toronto; ICES (Gomez, Saunders, Santiago, Baxter); Division of Pediatric Medicine (Saunders), The Hospital for Sick Children; Department of Pediatrics (Saunders), University of Toronto; Institute of Health Policy, Management and Evaluation (Saunders, Baxter), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia.
CMAJ. 2020 Oct 19;192(42):E1253-E1263. doi: 10.1503/cmaj.200722.
Firearm-related injury is an important and preventable cause of death and disability. We describe the burden, baseline characteristics and regional rates of firearm-related injury and death in Ontario.
We conducted a population-based cross-sectional study using linked data from health administrative data sets held at ICES. We identified residents of Ontario of all ages who were injured or died as a result of a firearm discharge between Apr. 1, 2002, and Dec. 31, 2016. We included injuries classified as assault, unintentional, self-harm or undetermined intent secondary to handguns, rifles, shotguns and larger firearms. The primary outcome was the incidence of nonfatal and fatal injuries resulting in an emergency department visit, hospital admission or death. We also describe regional and temporal rates.
We identified 6483 firearm-related injuries (annualized injury rate 3.54 per 100 000 population), of which 2723 (42.3%) were fatal. Assault accounted for 40.2% (1494/3715) of nonfatal injuries and 25.5% (694/2723) of deaths. Young men, predominantly in urban neighbourhoods, within the lowest income quintile were overrepresented in this group. Injuries secondary to self-harm accounted for 68.0% (1366/2009) of injuries and occurred predominantly in older men living in rural Ontario across all income quintiles. The case fatality rate of injuries secondary to self-harm was 91.7%. Self-harm accounted for 1842 deaths (67.6%).
We found that young urban men were most likely to be injured in firearm-related assaults and that more than two-thirds of self-harm-related injuries occurred in older rural-dwelling men, most of whom died from their injuries. This highlights a need for suicide-prevention strategies in rural areas targeted at men aged 45 or older.
与枪支相关的伤害是导致死亡和残疾的一个重要且可预防的原因。我们描述了安大略省与枪支相关的伤害和死亡的负担、基线特征及地区发生率。
我们利用ICES保存的卫生行政数据集的关联数据进行了一项基于人群的横断面研究。我们确定了2002年4月1日至2016年12月31日期间因枪支发射而受伤或死亡的安大略省所有年龄段居民。我们纳入了因手枪、步枪、霰弹枪和大型枪支导致的归类为袭击、无意、自残或意图不明的伤害。主要结局是导致急诊就诊、住院或死亡的非致命和致命伤害的发生率。我们还描述了地区和时间发生率。
我们确定了6483例与枪支相关的伤害（年化伤害率为每10万人3.54例），其中2723例（42.3%）是致命的。袭击占非致命伤害的40.2%（1494/3715）和死亡的25.5%（694/2723）。该群体中低收入五分位数、主要居住在城市社区的年轻男性占比过高。自残导致的伤害占伤害总数的68.0%（1366/2009），主要发生在安大略省农村地区所有收入五分位数的老年男性中。自残导致的伤害的病死率为91.7%。自残占1842例死亡（67.6%）。
我们发现年轻城市男性最有可能在与枪支相关的袭击中受伤，超过三分之二的自残相关伤害发生在农村老年男性中，其中大多数人因伤死亡。这凸显了针对45岁及以上男性的农村地区自杀预防策略的必要性。
