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
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Article info
Publication history
Published online: July 10, 2020
Accepted:
June 11,
2020
Received in revised form:
April 17,
2020
Received:
October 3,
2019
Footnotes
No conflicts to declare.
Meeting presentation: This was presented at Academic Surgical Congress, Houston, Texas on February 2019.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
