Advertisement

The Association of State Firearm Legislation With the Burden of Firearm-Related Surgery

      Abstract

      Background

      United States state-level firearm legislation is linked to rates of firearm-related suicides, pediatric injuries, nonfatal injuries, hospital discharges, and mortality. Our objective was to evaluate the burden of firearm-related injuries requiring surgery for states with strict as opposed to nonstrict firearm legislation.

      Materials and methods

      The 2014 Healthcare Cost and Utilization Project State Inpatient Database was utilized to extract data for all available 28 states and the District of Columbia. States were dichotomized into strict and nonstrict legislative categories using the 2014 Brady and Gifford's scores (15 strict, 14 nonstrict). Patients with a firearm injury requiring surgery were identified and the incidence of surgery aggregated to the county level. Negative binomial regression with an offset for county-level residential population was used to estimate the incident rate ratio for surgical volume comparing counties in strict and nonstrict states. Models were stratified by injury intent and adjusted for county population characteristics.

      Results

      A total of 11,939 patients were hospitalized with firearm-related injuries, with 65% (n = 7759) undergoing an operative procedure. The adjusted incidence rate of firearm-related surgery per 100,000 people was 1.29 (95% confidence interval; 1.13-1.46, P < 0.001) times higher and the adjusted cost of hospitalization per 100,000 people was $6028.69 ($3744.61-$8312.78, P = 0.001) greater for counties in nonstrict states than those for counties in strict states. The burden of health care for these injuries is invariably shifted to state- and county-level finances.

      Conclusions

      The rate of firearm-related surgical intervention was higher for states with nonstrict firearm legislation than that for states with strict legislation. States should reevaluate their firearm legislation to potentially reduce the burden of firearm-related surgery and health care costs.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Surgical Research
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Simonetti J.A.
        • Rowhani-Rahbar A.
        • Mills B.
        • Young B.
        • Rivara F.P.
        State firearm legislation and nonfatal firearm injuries.
        Am J Public Health. 2015; 105: 1703-1709
        • Krug E.G.
        • Mercy J.A.
        • Dahlberg L.L.
        • Zwi A.B.
        The world report on violence and health.
        Lancet. 2002; 360: 1083-1088
        • Kuhls D.A.
        • Campbell B.T.
        • Burke P.A.
        • et al.
        Survey of American College of Surgeons Committee on trauma members on firearm injury.
        J Trauma Acute Care Surg. 2017; 82: 877-886
        • Xu J.
        • Murphy S.L.
        • Kochanek K.D.
        • Bastian B.
        • Arias E.
        National vital statistics reports volume 67, Number 5 July 26, 2018, Deaths: Final Data for 2016.
        (Available at:)
        https://www.cdc.gov/
        Date: 2018
        Date accessed: March 18, 2019
        • Naghavi M.
        • Marczak L.B.
        • Kutz M.
        • et al.
        Global mortality from firearms, 1990-2016.
        JAMA. 2018; 320: 792
        • Gani F.
        • Canner J.K.
        Trends in the incidence of and charges associated with firearm-related injuries among pediatric patients, 2006-2014.
        JAMA Pediatr. 2018; 172: 1195
        • Herrera-Escobar J.P.
        • de Jager E.
        • McCarty J.C.
        • et al.
        Patient-reported outcomes at 6 to 12 Months among survivors of firearm injury in the United States.
        Ann Surg. 2020; 1
        • Fleegler E.W.
        • Lee L.K.
        • Monuteaux M.C.
        • Hemenway D.
        • Mannix R.
        Firearm legislation and firearm-related fatalities in the United States.
        JAMA Intern Med. 2013; 173: 732
        • Jehan F.
        • Pandit V.
        • O’Keeffe T.
        • et al.
        The burden of firearm violence in the United States: stricter laws result in safer states.
        J Inj Violence Res. 2018; 10: 11-16
        • Zeoli A.M.
        • Webster D.W.
        Firearm policies that work.
        JAMA. 2019; 321: 937
      1. The Brady Campaign state scorecard 2014.
        (Available at:)
        http://crimadvisor.com/data/Brady-State-Scorecard-2015.pdf
        Date: 2015
        Date accessed: March 18, 2019
        • Safavi A.
        • Rhee P.
        • Pandit V.
        • et al.
        Children are safer in states with strict firearm laws.
        J Trauma Acute Care Surg. 2014; 76: 146-151
        • Madhavan S.
        • Taylor J.S.
        • Chandler J.M.
        • Staudenmayer K.L.
        • Chao S.D.
        Firearm legislation stringency and firearm-related fatalities among children in the US.
        J Am Coll Surg. 2019; 229: 150-157
        • Conner K.R.
        • Zhong Y.
        State firearm laws and rates of suicide in men and women.
        Am J Prev Med. 2003; 25: 320-324
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • et al.
        The strengthening the reporting of observational studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        PLoS Med. 2007; 4: e296
        • Parker Tim
        United States department of agriculture economic research service.
        (Available at:)
        • Center for Disease Control and Prevention
        Proposed matrix of E-code groupings injury center.
        (Available at:)
      2. Law center to prevent gun violence. Giffords law center to prevent Gun violence - annual Gun law state scorecard.
        (Available at:)
        https://lawcenter.giffords.org/scorecard2014/
        Date: 2014
        Date accessed: March 18, 2019
        • Gardner W.
        • Mulvey E.P.
        • Shaw E.C.
        Regression analyses of counts and rates: Poisson, overdispersed Poisson, and negative binomial models.
        Psychol Bull. 1995; 118: 392-404
        • Lee J.
        • Quraishi S.A.
        • Bhatnagar S.
        • Zafonte R.D.
        • Masiakos P.T.
        The economic cost of firearm-related injuries in the United States from 2006 to 2010.
        Surgery. 2014; 155: 894-898
        • Spitzer S.A.
        • Staudenmayer K.L.
        • Tennakoon L.
        • Spain D.A.
        • Weiser T.G.
        Costs and financial burden of initial hospitalizations for firearm injuries in the United States, 2006–2014.
        Am J Public Health. 2017; 107: 770-774
        • Zeoli A.M.
        • Webster D.W.
        Firearm policies that work.
        JAMA. 2019; 321: 937-938
        • Hahn R.A.
        • Bilukha O.
        • Crosby A.
        • et al.
        Firearms laws and the reduction of violence: a systematic review.
        Am J Prev Med. 2005; 28: 40-71
        • Gani F.
        • Sakran J.V.
        • Canner J.K.
        Emergency department visits for firearm-related injuries in the United States, 2006–14.
        Health Aff. 2017; 36: 1729-1738
        • Peek-Asa C.
        • Butcher B.
        • Cavanaugh J.E.
        Cost of hospitalization for firearm injuries by firearm type, intent, and payer in the United States.
        Inj Epidemiol. 2017; 4: 20