Firearm injury in Alabama's pediatric patients: An assessment of neighborhood vulnerability and opportunity.

INTRODUCTION

The incidence of pediatric firearm injuries is increasing. While developed independently, Social Vulnerability Index (SVI) and Child Opportunity Index (COI) quantify socioeconomic disparities in pediatric populations although using different variables. There is scant research applying these indices to the incidence of pediatric firearm injuries. We aimed to investigate the association between SVI, COI, and pediatric firearm injuries seen at a state verified pediatric level one trauma center.

METHODS

We included children evaluated for firearm injury from 2016 to 2023 in a retrospective cohort study. Patient's residence was linked to concordant year SVI (high indicating higher vulnerability) and state COI (low indicating worse opportunity). SVI and COI quartiles were created; bivariate analysis compared demographics and patient outcomes by quartiles for each index. Incidence rate ratios (IRR) compared SVI and COI quartiles using CDC population variables.

RESULTS

554 children were included. Majority were Black (68.2%) and male (70.4%) with a median (IQR) age of 11.4 years (4.3-15.0). A higher proportion of Black children and patients using government insurance were in higher SVI and lower COI cohorts (p < 0.001). Sex, age, hospital length of stay, and mortality was similar between the SVI and COI quartiles. The IRR increased with increasing SVI and decreasing COI quartiles, compared to the Very Low quartiles, respectively, which persisted when examining the themes of each database.

CONCLUSIONS

The incidence of firearm injury was increased in children from areas with increased socioeconomic, racial, ethnic inequities and in those from less advantaged neighborhoods. These data will be useful in identifying areas to target for future interventions to address pediatric firearm injuries.