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. 2017 Aug;107(8):1324-1328.
doi: 10.2105/AJPH.2017.303837. Epub 2017 Jun 22.

Constant Lethality of Gunshot Injuries From Firearm Assault: United States, 2003-2012

Philip J Cook  1 , Ariadne E Rivera-Aguirre  1 , Magdalena Cerdá  1 , Garen Wintemute  1
Affiliations

Constant Lethality of Gunshot Injuries From Firearm Assault: United States, 2003-2012

Philip J Cook et al. Am J Public Health. 2017 Aug.

Abstract

Objectives: To investigate the validity of the apparent downward trend in the national case-fatality rate for gunshot wounds from assault.

Methods: We reanalyzed the estimated annual number of nonfatal firearm injuries the National Electronic Injury Surveillance System reported from 2003 to 2012. We adjusted the estimates for discontinuities created by the substitution of 1 hospital for another in the sample and for a downward trend in the percentage of gunshot injuries classified as "unknown circumstance." Firearm homicide data are from the Centers for Disease Control and Prevention, Web-based Injury Statistics Query and Reporting System.

Results: The unadjusted National Electronic Injury Surveillance System estimate increased by 49%, yielding a decline in the case-fatality rate from 25% to 18%. Our adjustments eliminated these trends; the case-fatality rate was 22% in both 2003 and 2012.

Conclusions: With reasonable adjustments, the trend in nonfatal injuries from interpersonal firearms assault tracks the flat trend in firearms homicides, suggesting that there was no increase in firearms violence during this period. The case-fatality rate did not change, and trauma care improvements did not influence the firearms homicide trend.

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Figures

FIGURE 1—
FIGURE 1—
Number of Persons With Nonfatal Firearm Injuries From Assault Treated in National Electronic Injury Surveillance System—All Injury Program–Sample Emergency Departments: United States, 2003–2012 Note. PSU = primary sampling unit. Sample emergency departments were PSUs in which the sample hospital was replaced sometime during 2003 and 2012. Unweighted. “0” indicates firearm-related injuries occurred but were not classified as assault. *The hospital did not report any firearm-related injury.
FIGURE 2—
FIGURE 2—
Number of Persons With Nonfatal Firearm Injuries From Assault Treated in National Electronic Injury Surveillance System—All Injury Program–Sample Emergency Departments: United States, 2003–2012 Note. PSU = primary sampling unit. Sample emergency departments were PSUs in which the sample hospital was replaced sometime during 2003 and 2012. Counts multiplied by National Electronic Injury Surveillance System—All Injury Program national weights. “0” indicates firearm-related injuries occurred but were not classified as assault. *The hospital did not report any firearm-related injury.
FIGURE 3—
FIGURE 3—
National Estimates of the Number of Persons With Nonfatal Firearm Injuries From Assault Treated in Hospital Emergency Departments in Primary Sampling Units (PSUs) With Replacements and PSUs Without Replacements: United States, 2003–2012
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Comment in

  • Cook et al. Respond.
    Cook PJ, Rivera-Aguirre AE, Cerdá M, Wintemute G. Cook PJ, et al. Am J Public Health. 2017 Dec;107(12):e23. doi: 10.2105/AJPH.2017.304101. Am J Public Health. 2017. PMID: 29116836 Free PMC article. No abstract available.
  • Understanding Increased Mortality After Gunshot Injury.
    Kent AJ, Sakran JV, Efron DT, Haider AH, Cornwell EE 3rd, Haut ER. Kent AJ, et al. Am J Public Health. 2017 Dec;107(12):e22-e23. doi: 10.2105/AJPH.2017.304100. Am J Public Health. 2017. PMID: 29116838 Free PMC article. No abstract available.

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