Is racism to blame for recurrent firearm injury among children?

Children who have a history of firearm injury remain at increased risk for encountering another firearm injury, reports a US study.

“[T]his study highlights the high cumulative incidence of children experiencing recurrent firearm injuries in St. Louis, [Missouri, US], and identifies racial and social vulnerability disparities in this group,” the researchers said. 

“Findings also indicate the disproportionate risk for recurrent firearm injury for children whose index firearm injury was treated at an adult hospital rather than at a children’s hospital,” they added.

This multicentre, observational, cohort study was conducted at two adult and two paediatric level I trauma hospitals in St. Louis, Missouri. Paediatric patients aged 0 to 17 years presenting with an index firearm injury between 2010 and 2019 were included.

The research team obtained data on firearm-injured patient demographics, hospital and diagnostic information, health insurance status, and mortality from the St. Louis Region-Wide Hospital-Based Violence Intervention Program Data Repository. They also described the social vulnerability of the census tracts of patients’ residences using the Social Vulnerability Index.

Finally, descriptive statistics and time-to-event analyses were done to estimate the cumulative incidence of experiencing a recurrent firearm injury among children.

Overall, 1,340 children presented with an index firearm injury over 10 years. Most of these patients were Black (87 percent), non-Hispanic (99 percent), male (84 percent), and between the ages of 15 and 17 years (67 years). [Ann Intern Med 2024;doi: 10.7326/M24-0430]

Firearm reinjury in this population was estimated to be 6 percent at 1 year and 14 percent at 5 years after the initial injury. Notably, male children and those seen at an adult hospital were at higher risk for recurrent firearm injury.

“Interventions are needed to reduce reinjury and address inequities in the demographic and clinical profiles within this cohort of children,” the researchers said.

Racism

An earlier study has pointed at structural racism in the US as the “driving force” behind firearm injury disparities, showing a direct association between Black and White racial segregation in US urban areas and firearm mortality. [J Trauma Acute Care Surg 2021;91:64-71]

Structural racism could be one of the main reasons for the firearm injury epidemic in St. Louis, which is in the top 10 most racially segregated cities in the US and in the top 5 for firearm homicide rates. [J Trauma Acute Care Surg 2021;91:64-71; www.brookings.edu/blog/the-avenue/2018/12/17/black-white-segregation-edges-downward-since-2000-census-shows]

“In addition, although children between the ages of 15 and 17 years comprised most of the study sample, we would be remiss not to highlight the fact that 13 percent of paediatric firearm injuries (n=179) occurred in children under the age of 10 years,” the researchers said. 

“The representation of youth aged 0 to 9 years in our study sample is higher than national estimates, which indicate that roughly 7 percent of paediatric firearm injuries occur within this age group,” they added. [J Pediatr Surg 2020;55:1596-1603]

Such finding highlights the presence of violence in the home, school, and community where St. Louis children reside, according to the researchers.

“Future research will delve into which children receive treatment at adult hospitals, and if there are causal pathways linking children’s hospital care to lower risk for recurrent injury,” they said.