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Racial/Ethnic Differences in Pediatric Trauma Center Visits for Firearm Injuries, 2009 -2012
Gretchen J. Cutler, PhD, MPH, Henry W. Ortega, MD, Anupam B. Kharbanda, MD, MSc. Children's Minnesota, Minneapolis, MN, USA.

Background: Firearm injuries (FI) are a leading cause of death and disability in children, but there is a lack of research on how trends in trauma center visits differ by race/ethnicity.

Methods: We examined patients less than 19 years of age treated at trauma centers contributing to the National Trauma Data Bank, 2009-2012. We used Cochran-Armitage trend tests to examine change over time, and multivariable logistic regression to identify risk factors.

Results: We examined 529,896 trauma patients, of which 20,215 (3.8%) sustained a FI. The majority of FI were classified as assault (76.6%), followed by unintentional (14.4%) and self-inflicted (4.6%). Visits for any type of FI decreased from 2009 to 2012 in black and Hispanic patients (14.0% to 12.1%, p trend=<.0001; 5.6% to 3.9%, p trend=<.0001, respectively), but not in white patients (1.2% to 1.2%, p trend=0.77). FI classified as assault decreased in white and black patients (43.9% to 35.2%, p trend=<.0001; 86.1% to 84.3%, p trend=0.04, respectively), but FI classified as unintentional increased (33.5% to 40.9%, p trend=0.001 (white); 8.3% to 10.0%, p trend=0.007 (black)). In models adjusting for age, sex, and insurance status, odds of an assault FI were over 8 times higher in black and Hispanic patients compared to white (OR=8.38, 95% CI:7.66-9.17; OR=8.51, 95% CI:7.57-9.56, respectively).

Conclusions: There are large racial/ethnic disparities in FI in pediatric trauma patients. While overall FI visits significantly decreased over time in black and Hispanic patients, we found a concerning increase in FI classified as unintentional in white and black patients.

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