Kauffman Jeremy, Nance Michael, Cannon Jeremy W, Sakran Joseph Victor, Haut Elliott R, Scantling Dane R, Rozycki Grace, Byrne James P
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Trauma Surg Acute Care Open. 2024 Aug 14;9(1):e001458. doi: 10.1136/tsaco-2024-001458. eCollection 2024.
Firearm-related injury is the leading cause of death among children and adolescents. There is a need to clarify the association of neighborhood environment with gun violence affecting children. We evaluated the relative contribution of specific social determinants to observed rates of firearm-related injury in children of different ages.
This was a population-based study of firearm injury in children (age <18 years) that occurred in Philadelphia census tracts (2015-2021). The exposure was neighborhood Social Deprivation Index (SDI) quintile. The outcome was the rate of pediatric firearm injury due to interpersonal violence stratified by age, sex, race, and year. Hierarchical negative binomial regression measured the risk-adjusted association between SDI quintile and pediatric firearm injury rate. The relative contribution of specific components of the SDI to neighborhood risk of pediatric firearm injury was estimated. Effect modification and the role of specific social determinants were evaluated in younger (<15 years old) versus older children.
927 children were injured due to gun violence during the study period. Firearm-injured children were predominantly male (87%), of black race (89%), with a median age of 16 (IQR 15-17). Nearly one-half of all pediatric shootings (47%) occurred in the quintile of highest SDI (Q5). Younger children represented a larger proportion of children shot in neighborhoods within the highest (Q5), compared with the lowest (Q1), SDI quintile (25% vs 5%; p<0.007). After risk adjustment, pediatric firearm-related injury was strongly associated with increasing SDI (Q5 vs Q1; aRR 14; 95% CI 6 to 32). Specific measures of social deprivation (poverty, incomplete schooling, single-parent homes, and rented housing) were associated with significantly greater increases in firearm injury risk for younger, compared with older, children. Component measures of the SDI explained 58% of observed differences between neighborhoods.
Neighborhood measures of social deprivation are strongly associated with firearm-related injury in children. Younger children appear to be disproportionately affected by specific adverse social determinants compared with older children. Root cause evaluation is required to clarify the interaction with other factors such as the availability of firearms and interpersonal conflict that place children at risk in neighborhoods where gun violence is common.
Level III - Observational Study.
与枪支相关的伤害是儿童和青少年死亡的主要原因。有必要阐明邻里环境与影响儿童的枪支暴力之间的关联。我们评估了特定社会决定因素对不同年龄段儿童观察到的枪支相关伤害发生率的相对贡献。
这是一项基于人群的研究，研究对象为费城普查区（2015 - 2021年）发生的18岁以下儿童枪支伤害事件。暴露因素为邻里社会剥夺指数（SDI）五分位数。结局指标是按年龄、性别、种族和年份分层的人际暴力导致的儿童枪支伤害发生率。分层负二项回归测量了SDI五分位数与儿童枪支伤害发生率之间的风险调整关联。估计了SDI特定组成部分对儿童枪支伤害邻里风险的相对贡献。在年龄较小（<15岁）和较大儿童中评估了效应修正和特定社会决定因素的作用。
在研究期间，927名儿童因枪支暴力受伤。受枪支伤害的儿童主要为男性（87%），黑人（89%），中位年龄为16岁（四分位间距15 - 17岁）。几乎一半的儿童枪击事件（47%）发生在SDI最高五分位数（Q5）区域。与SDI最低五分位数（Q1）区域相比，年龄较小的儿童在SDI最高（Q5）区域枪击儿童中所占比例更大（25%对5%；p<0.007）。经过风险调整后，儿童枪支相关伤害与SDI升高密切相关（Q5对Q1；调整后风险比14；95%置信区间6至32）。与年龄较大的儿童相比，社会剥夺的特定指标（贫困、未完成学业、单亲家庭和租房）与年龄较小儿童枪支伤害风险的显著更大增加相关。SDI的组成指标解释了邻里间观察到差异的58%。
邻里社会剥夺指标与儿童枪支相关伤害密切相关。与年龄较大的儿童相比，年龄较小的儿童似乎受到特定不良社会决定因素的影响更大。需要进行根本原因评估，以阐明与其他因素（如枪支可获得性和人际冲突）的相互作用，这些因素使儿童在枪支暴力常见的邻里中面临风险。
III级 - 观察性研究。
