Firearm-related hospitalization associated with subsequent violent victimization and crime perpetration

1. In this study of hospitalizations in Washington State, patients with firearm-related injuries were more likely to experience subsequent firearm-related hospitalization and death.

2. Patients hospitalized for firearm-related reasons were also more likely to have firearm- or violence-related arrests.

Evidence Rating Level: 2 (Good)

Study Rundown: Firearm-related injuries, primarily from assault, send thousands of Americans to the emergency room each year. To determine these patients’ risk for future violent injury, death, or arrest following discharge, this study evaluated patients with a firearm-related hospitalization (FRH) and their subsequent outcomes after hospitalization. Compared to matched patients who were hospitalized for non-injuries, patients who experienced an FRH were at significantly higher risk for subsequent firearm-related hospitalization, death, and arrest. FRH was also associated with increased risk of non-firearm related assault leading to hospitalization or death. Although this analysis used data on all recorded hospitalizations in the state of Washington between 2006-2007, its results may be potentially limited by missing data, such as patients who may have moved out of state following hospital discharge. Furthermore, due to the nature of the available dataset, the analysis only partially controlled for factors that may also have contributed to encounters with the medical and legal systems following FRH, such as the socioeconomic characteristics of these patients. Nevertheless, the results of this study suggest that hospitalizations following firearm-related injury may be crucial opportunities for public health and clinical care interventions to protect these high-risk patients from subsequent harm.

Click to read the study, published today in the Annals of Internal Medicine

Relevant Reading: Firearm Legislation and Firearm-Related Fatalities in the United States

In-Depth [retrospective cohort]: This study compared the 680 firearm-related hospitalizations with 180,841 non-injury hospitalizations that occurred in Washington between 2006-2007. Follow-up data on patients’ further encounters with the medical and legal systems was gathered from state medical and police databases through 2011. After adjusting for available confounders (i.e., age, sex, insurance payer status, year and season of discharge, and county of admitting hospital), patients with a first FRH had significantly higher rates of subsequent FRH (subhazard ratio 21.2, 95%CI 7.0-64.0), firearm-related death (sHR 4.3, 95%CI 1.3-14.1), and firearm- or violence-related arrest (sHR 2.7, 95%CI 2.0-3.5). Notably, 51% of FRHs were the result of assault, and 9.9% of patients died during their index FRH. Together, these results suggest that FRHs may serve as an important identifier of patients at high risk for subsequent victimization from violence or perpetration of crime.

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