Advertisement

Geospatial analysis of firearm injuries in an urban setting: Individual rather than community characteristics affect firearm injury risk

Published:January 16, 2023DOI:https://doi.org/10.1016/j.amjsurg.2023.01.014

      Highlights

      • Geospatial analysis of individual & community risk factors for firearm injury.
      • Firearm injuries cluster in neighborhoods of low socio-economic status.
      • Black race and male sex are associated with 5x higher risk of firearm injury.
      • Individual characteristics affect firearm injury risk more than community factors.
      • Injury prevention efforts should focus on young, Black men in urban centers.

      Abstract

      Background

      The relationship between individual/socioeconomic characteristics and firearm injury risk in an urban center was evaluated.

      Methods

      A hospital registry was used to identify individuals in Baltimore City who experienced interpersonal firearm injury in 2019 (FA). Injuries that did not satisfy this criterion were used as a comparison group (NF). Socioeconomic characteristics were linked to home address at the block group level. Regression analysis was used to determine predictors of firearm injury. Clusters of high and low firearm relative to non-firearm injuries were identified.

      Results

      A total of 1293 individuals were included (FA = 277, NF = 1016). The FA group lived in communities with lower income (p = 0.005), higher poverty (p = 0.007), and more Black residents (p < 0.001). Individual level factors were stronger predictors of firearm injury than community factors on multivariate regression with Black race associated with 5x higher odds of firearm injury (p < 0.001). Firearm injury clustered in areas of low socioeconomic status.

      Conclusions

      Individual versus community factors have a greater influence on firearm injury risk. Prevention efforts should target young, Black men in urban centers.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Marmot M.
        Social determinants of health inequalities.
        Lancet. 2005 Mar 19; 365: 1099-1104
        • Wong M.D.
        • Shapiro M.F.
        • Boscardin W.J.
        • Ettner S.L.
        Contribution of major diseases to disparities in mortality.
        N Engl J Med. 2002 Nov 14; 347: 1585-1592
        • Primm A.B.
        • Vasquez M.J.T.
        • Mays R.A.
        • et al.
        The role of public health in addressing racial and ethnic disparities in mental health and mental illness.
        Prev Chronic Dis. 2009 Dec 15; 7
        • Saeednejad M.
        • Sadeghian F.
        • Fayaz M.
        • et al.
        Association of social determinants of health and road traffic deaths: a systematic review.
        Bull Emerg Trauma. 2020 Oct; 8: 211-217
        • Marmot M.G.
        • Bell R.
        Action on health disparities in the United States: commission on social determinants of health.
        JAMA. 2009 Mar 18; 301: 1169-1171
        • Franks P.
        • Muennig P.
        • Lubetkin E.
        • Jia H.
        The burden of disease associated with being African-American in the United States and the contribution of socio-economic status.
        Soc Sci Med. 2006 May 1; 62: 2469-2478
        • Sorlie P.
        • Rogot E.
        • Anderson R.
        • Johnson N.J.
        • Backlund E.
        Black-white mortality differences by family income.
        Lancet. 1992 Aug; 340: 346-350
        • Gaskin D.J.
        • Dinwiddie G.Y.
        • Chan K.S.
        • McCleary R.
        Residential segregation and disparities in health care services utilization.
        Med Care Res Rev. 2012 Apr; 69: 158-175
        • Butkus R.
        • Doherty R.
        • Bornstein S.S.
        For the health and public policy committee of the American college of physicians. Reducing firearm injuries and deaths in the United States: a position paper from the American college of physicians.
        Ann Intern Med. 2018 Nov 20; 169: 704
        • Ali A.
        • Broome J.
        • Tatum D.
        • et al.
        The association between food insecurity and gun violence in a major metropolitan city.
        J Trauma Acute Care Surg. 2022 Mar 1;
        • Goin D.E.
        • Rudolph K.E.
        • Ahern J.
        Predictors of firearm violence in urban communities: a machine-learning approach.
        Health Place. 2018 May; 51: 61-67
        • Irani D.D.
        • Siers M.
        • Rice M.
        • Bast E.
        Human Development Index Disparities in Baltimore City.
        ([Internet]) Regional Economic Studies Institute, Towson University, 2018 Jun: 84 (Available from:)
        • Kegler S.R.
        • Dahlberg L.L.
        • Vivolo-Kantor A.M.
        A descriptive exploration of the geographic and sociodemographic concentration of firearm homicide in the United States, 2004–2018.
        Prev Med. 2021 Dec 1; 153106767
      1. Underlying Cause of Death. 1999 (2020 Results Form [Internet]. [cited 2022 Aug 1]. Available from:)
        • Baker S.P.
        • O’neill B.
        • Haddon W.J.
        • Long W.B.
        The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care.
        J Trauma Acute Care Surg. 1974 Mar; 14: 187-196
        • Palmer C.
        Major trauma and the injury severity score - where should we set the bar?.
        Annu Proc Assoc Adv Automot Med. 2007; 51: 13-29
        • Waller Lance A.
        • Gotway Carol A.
        Applied Spatial Statistics for Public Health Data.
        ([Internet])first ed. Wiley-Interscience, ebook2004 (Available from:)
        • Davies T.M.
        • Marshall J.C.
        • Hazelton M.L.
        Tutorial on kernel estimation of continuous spatial and spatiotemporal relative risk.
        Stat Med. 2018 Mar 30; 37: 1191-1221
        • Diggle P.
        Statistical Analysis of Spatial Point Patterns.
        Arnold, 2003: 159
      2. El-Shaarawi A.H. Piegorsch W.W. Encyclopedia of Environmetrics. Wiley, Chichester ; New York2002: 1796-1803
      3. SaTScan v9.7. Information Management Services, Inc, Boston, MA2021
        • Pizarro J.
        • Zeoli A.
        • Grady S.
        • Melde C.
        Homicide as infectious disease: using public health methods to investigate the diffusion of homicide.
        Justice Q JQ. 2012 Nov 30; : 31
        • Amin R.
        • Nabors N.S.
        • Nelson A.M.
        • Saqlain M.
        • Kulldorff M.
        Geographical clusters of rape in the United States: 2000-2012.
        Stat Public Policy Phila Pa. 2015; 2: 87-92
        • Thurston H.
        • Freisthler B.
        • Bell J.
        • et al.
        The temporal-spatial distribution of seriously maltreated children.
        Spat Spatio-Temporal Epidemiol. 2017 Feb; 20: 1-8
      4. ArcGIS Pro 2.9.0. Environmental Systems Research Institute, Redlands, CA2021
        • Rstudio
        Integrated Development Environment for R.
        RStudio, PBC, Boston, MA2021
      5. Stata Statistical Software: Release 17. StataCorp LLC, College Station, TX2021
        • Map Gallery
        Bnia – Baltimore neighborhood indicators alliance.
        ([Internet]. [cited 2022 Aug 2]. Available from:)
        • Webster D.W.
        • Buggs S.A.L.
        • Crifasi C.K.
        Estimating the Effects of Law Enforcement and Public Health Interventions Intended to Reduce Gun Violence in Baltimore.
        Johns Hopkins Center for Gun Policy and Research, 2018 Jan
        • Chong V.E.
        • Lee W.S.
        • Victorino G.P.
        Neighborhood socioeconomic status is associated with violent reinjury.
        J Surg Res. 2015 Nov 1; 199: 177-182
        • Beard J.H.
        • Morrison C.N.
        • Jacoby S.F.
        • et al.
        Quantifying disparities in urban firearm violence by race and place in Philadelphia, Pennsylvania: a cartographic study.
        Am J Publ Health. 2017 Mar; 107: 371-373
        • Dong B.
        • White C.M.
        • Weisburd D.L.
        Poor health and violent crime hot spots: mitigating the undesirable Co-occurrence through focused place-based interventions.
        Am J Prev Med. 2020 Jun; 58: 799-806
        • Cooper C.
        • Eslinger D.M.
        • Stolley P.D.
        Hospital-based violence intervention programs work.
        J Trauma Inj Infect Crit Care. 2006 Sep; 61: 534-540
        • Purtle J.
        • Dicker R.
        • Cooper C.
        • et al.
        Hospital-based violence intervention programs save lives and money.
        J Trauma Acute Care Surg. 2013 Aug; 75: 331-333
        • Webster D.W.
        • Whitehill J.M.
        • Vernick J.S.
        • Curriero F.C.
        Effects of Baltimore's Safe Streets program on gun violence: a replication of chicago's CeaseFire program.
        J Urban Health Bull N Y Acad Med. 2013 Feb; 90: 27-40
      6. Skogan WG. Evaluation of CeaseFire-(Chicago).

        • Kaufman E.
        • Holena D.N.
        • Yang W.P.
        • et al.
        Firearm assault in Philadelphia, 2005–2014: a comparison of police and trauma registry data.
        Trauma Surg Acute Care Open. 2019 Aug 12; 4 ([cited 2021 Feb 11]) (Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699718/)
        • Rich J.A.
        • Grey C.M.
        Pathways to recurrent trauma among young Black men: traumatic stress, substance use, and the “code of the street.
        Am J Publ Health. 2005 May; 95: 816-824
        • Tita G.E.
        • Radil S.M.
        Spatializing the social networks of gangs to explore patterns of violence.
        J Quant Criminol. 2011 Dec 1; 27: 521-546
        • U.S. Census Bureau
        (QuickFacts: Baltimore city (County), Maryland [Internet]. [cited 2023 Jan 9]. Available from:)