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Pediatric Firearm-Related Injuries: Racial Disparities in the United States
Byron D. Hughes, MD, MPH; Hemal B. Mehta, PhD; Yong Shan, PhD; Ravi S. Radhakrishnan, MD, MBA, FACS, FAAP; Kanika A. Bowen-Jallow, MD, MMS, FACS, FAAP
The University of Texas Medical Branch, Galveston, TX

Background
Among developed countries, the U.S. has the highest rate of firearm-related injury. Known racial disparities exist for firearm injuries. The objective was to determine hospitalization rates for firearm-related injuries and associated outcomes among the pediatric population by race.

Methods
A retrospective cohort study using the Kids' Inpatient Database from 2006, 2009, and 2012 was conducted. Patients hospitalized for firearm injury were included and classified as unintentional, assault, suicide, and undetermined. Descriptive statistics were used to describe the hospitalization rates for different types of injuries by racial groups. Across racial groups, we compared length of stay (LOS) and cost using t-test and inpatient-mortality using chi-square test.

Results
36,363 patients were hospitalized due to firearm injury. The most common injuries were unintentional (63.5%) and assault (31.9%). The types of firearm injury differed significantly by race (p<0.001). Of total assault injuries (n=11,616), the majority occurred in Blacks (52.2%) and Hispanics (21.3%). In unintentional injuries (n=23,114), the majority occurred in Whites (43.13%), followed by Blacks (19%). LOS and cost associated with firearm-related injury were 6.2 ( 12.8) days and $53,726 ( $118,226). The in-patient mortality rate was 3.5%. Black and Hispanic children hospitalized for assault injury had a significantly longer LOS and higher mortality compared to Whites. However, the cost of admission was higher in White and Hispanics compared to Blacks. Total costs across the study period were $1.9 billion.

Conclusion
Racial disparities among children hospitalized for firearm-related injuries persist. Development of public health programming at the community and hospital-level may improve outcomes.


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