Trends, disparities, and outcomes of pediatric firearm-related injuries in the United States: A national analysis from 2016 to 2021.

BACKGROUND

Firearm-related injuries have become the leading cause of death among US children and adolescents, yet the evolving epidemiology and disparities in pediatric firearm hospitalizations remain poorly characterized.

STUDY

DESIGN

This was a retrospective study of the 2016-2021 National Inpatient Sample database. Pediatric (<18 years) firearm-related hospitalizations were identified and categorized by injury intent, including unintentional, assault, self-harm, or other. Hospitalizations were further assessed based on the nine geographic divisions defined by the US Census Bureau. Primary outcomes were annual hospitalization rates and in-hospital mortality. Multivariable logistic regression was performed to assess factors associated with hospitalization outcomes, while temporal and regional trends were evaluated using adjusted population-based analyses.

RESULTS

Among an estimated 20,270 pediatric firearm hospitalizations, unintentional injuries accounted for 49.7%, followed by assault (40.5%). From 2016-2021, firearm hospitalizations increased by 52.4%, with unintentional injuries surpassing assault-related cases by 2021 (55.2% vs 38.4%, nptrend<0.001). In-hospital mortality increased from 6.7% to 9.8%, with the largest change observed in unintentional injuries (nptrend<0.001). Firearm-related hospitalizations disproportionately affected racial minority children and those from lower-income households across all injury intents. Additionally, Black children were disproportionately affected by assault-related injuries, while self-harm injuries were more common among White adolescents. The East South-Central region demonstrated the highest hospitalization rates, with increasing incidence over time.

CONCLUSIONS

Pediatric firearm injuries have increased substantially, with shifting injury mechanisms and widening demographic disparities. Future efforts should focus on targeted prevention strategies and policy measures addressing firearm accessibility, storage practices and community-based interventions to reduce injury burden.