Trends and disparities in gun violence-related neurotrauma incidence, prevalence, and disability across the United States, 1990-2023: A population-based analysis of the Global Burden of Disease database.

To characterize temporal, regional, sex-based, and sociodemographic disparities in firearm-related traumatic brain injury (TBI) and spinal cord injury (SCI) in the United States (1990-2023), and to evaluate associations with state-level development and care quality. National incidence, prevalence, and years lived with disability (YLDs) per 100,000 were obtained from the Global Burden of Disease 2023 database. States were grouped into Northeast, Midwest, South, and West regions. Human Development Index (HDI) data were retrieved from the Global Data Lab. A Quality of Care Index (QCI) was derived from scaled prevalence-to-incidence, YLD-to-prevalence, and YLD-to-incidence ratios. Regional variation was assessed with ANOVA; HDI correlations used Pearson's r. In 2023, firearm-related TBI incidence, prevalence, and YLDs were 1.29, 2.75, and 0.39 per 100,000; for SCI, 0.30, 9.77, and 2.32. From 1990 to 2023, TBI burden rose substantially (incidence + 31.7%; prevalence + 35.5%; YLDs + 34.5%), while SCI increased marginally (≤ 6%). The South exhibited the highest burden (p < 0.001). Males had greater rates than females (p < 0.001). HDI correlated inversely with TBI and SCI burden (R²≈0.30-0.38). QCI scores for TBI and SCI each correlated with HDI at a similar moderate magnitude (TBI: R²=0.322; SCI: R²=0.336). Firearm-related neurotrauma has escalated over three decades, driven by rising TBI incidence and marked regional and socioeconomic disparities, highlighting the need for equitable prevention and rehabilitative care.