Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Penn Urban Health Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Ann Emerg Med. 2021 May;77(5):469-478. doi: 10.1016/j.annemergmed.2020.10.014. Epub 2020 Dec 17.
We evaluate the association between living near a neighborhood shooting and emergency department (ED) utilization for stress-responsive complaints.
In this location-based before-and-after neighborhood study, we examined variability in ED encounter volume for stress-responsive complaints after neighborhood shooting incidents around 2 academic hospitals. We included patients residing within 1/8- and 1/2-mile-diameter buffers around a shooting (place) if their ED encounter occurred 7, 30, or 60 days before or after the shooting (time). Prespecified outcomes were stress-responsive complaints (chest pain, lightheadedness, syncope, hypertension, shortness of breath, asthma, anxiety, depression, and substance use) based on prior literature for stress-responsive diseases. Conditional logistic regression was used to calculate the odds of presentation to the ED with a stress-responsive complaint after, compared with before, a neighborhood shooting incident.
Between January 2013 and December 2014, 513 shooting incidents and 19,906 encounters for stress-responsive complaints were included in the analysis. Mean age was 50.3 years (SD 22.3 years), 61.5% were women, and 91% were black. We found increased odds of presenting with syncope in 2 place-time buffers: 30 days in the 1/8-mile buffer (odds ratio 2.61; 99% confidence interval 1.2 to 5.67) and 60 days in 1/8-mile buffer (odds ratio 1.56; 99% confidence interval 0.99 to 2.46). No other chief complaints met our statistical threshold for significance.
This study evaluated the relationship between objectively measured gun violence exposure and short-term health effect at a microspatial scale. Overall, this was a study with largely negative results, and we did not find any consistent dose-response pattern in time or space regarding neighborhood shootings and stress-responsive presentations to the ED. Theoretic links make this relationship plausible, however, and further investigation is needed to understand the short-term health consequences of violence exposure, and whether those vary based on the circumstances that are experienced inherently by residents of a given neighborhood.
我们评估了居住在邻里枪击事件附近与因应激相关的疾病到急诊就诊之间的关联。
在这项基于地点的前后邻里研究中，我们研究了在两所学术医院周围发生邻里枪击事件后，因应激相关疾病到急诊就诊的患者数量的变化。如果患者的急诊就诊发生在枪击事件发生前或发生后 7、30 或 60 天内，且其居住在枪击事件发生地周围 1/8 英里或 1/2 英里直径的缓冲区（地点）内，则将其纳入研究。根据先前应激相关疾病的文献，预先指定的结局是应激相关的投诉（胸痛、头晕、晕厥、高血压、呼吸急促、哮喘、焦虑、抑郁和药物滥用）。使用条件逻辑回归计算与邻里枪击事件前后相比，因应激相关疾病到急诊就诊的可能性。
在 2013 年 1 月至 2014 年 12 月期间，共纳入 513 起枪击事件和 19906 起应激相关投诉的就诊事件。患者平均年龄为 50.3 岁（标准差 22.3 岁），61.5%为女性，91%为黑人。我们发现，在两个地点-时间缓冲区中，晕厥的就诊可能性增加：在 1/8 英里缓冲区中 30 天（优势比 2.61；99%置信区间 1.2 至 5.67）和 1/8 英里缓冲区中 60 天（优势比 1.56；99%置信区间 0.99 至 2.46）。其他主要投诉没有达到我们统计学显著水平的阈值。
这项研究评估了客观测量的枪支暴力暴露与微观空间尺度下的短期健康影响之间的关系。总体而言，这是一项结果大多为阴性的研究，我们没有发现邻里枪击事件与因应激相关的到急诊就诊之间在时间或空间上存在一致的剂量-反应模式。理论联系使这种关系具有合理性，但是需要进一步研究来了解暴力暴露的短期健康后果，以及这些后果是否因特定社区居民所经历的情况而有所不同。
