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Relationships between socioeconomic deprivation and pediatric firearm-related injury at the neighborhood level

Significant inequities exist in the rates of pediatric firearm-related injuries. This study shows that a child’s neighborhood context profoundly impacts their risk of firearm injury, with black children and children from disadvantaged neighborhoods bearing the greatest burden. BACKGROUND Disparities in pediatric injury are widely documented and partly driven by differential exposures to social determinants of health (SDH). Here, we examine associations between neighborhood-level SDH and pediatric firearm-related injury admissions as a step to defining specific targets for interventions to prevent injury. METHODS We conducted a retrospective review of patients 16 years or younger admitted to our Level I pediatric trauma center (2010–2019) after a firearm-related injury. We extracted patients’ demographic characteristics and intent of injury. We geocoded home addresses to enable quantification of injury-related admissions at the neighborhood (census tract) level. Our population-level exposure variable was a socioeconomic deprivation index for each census tract. RESULTS Of 15,686 injury-related admissions, 140 were for firearm-related injuries (median age, 14 years; interquartile range, 11–15 years). Patients with firearm-related injuries were 75% male and 64% Black; 66% had public insurance. Nearly half (47%) of firearm-related injuries were a result of assault, 32% were unintentional, and 6% were self-inflicted; 9% died. At the neighborhood level, the distribution of firearm-related injuries significantly differed by deprivation quintile (p < 0.05). Children from the highest deprivation quintile experienced 25% of injuries of all types, 57% of firearm-related injuries, and 70% of all firearm-related injuries from assault. They had an overall risk of firearm-related injury 30 times that of children from the lowest deprivation quintile. CONCLUSION Increased neighborhood socioeconomic deprivation is associated with more firearm-related injuries requiring hospitalization, at rates far higher than injury-related admissions overall. Addressing neighborhood-level SDH may help prevent pediatric firearm-related injury. LEVEL OF EVIDENCE Prognostic and epidemiological, Level III.