Gunshot Injuries in California Drop, but Percentage of Firearm Death Goes Up
“The increase in the overall CFR may be due to a rise in the proportion of self-inflicted firearm injuries, which are usually deadlier than the other types of firearm injuries,” said Spitzer, currently a general surgery resident at Brigham and Women’s Hospital.
Nonfatal Firearm Injuries by Race and Income
The study also found significant differences in income and source of payment for medical care by cause of injury. Those with assault-related injuries were more likely to be within the lowest income quartile (30%) and have self-pay (33%) or government coverage (37%).
Consistent with previous studies, it found that assaultive injuries were concentrated among young Black (33%) and Hispanic (46%) individuals from urban, lower income areas. In fact, Black men had an assault-related injury rate four times that of Hispanic men, the next highest racial group in terms of such injuries. The average age of individuals with assault-related injuries was 27 years.
Self-inflicted injuries were more likely older (average of 42 years) and concentrated among white (62%) individuals in higher income areas. Self-inflicted gunshot wounds are usually more severe than other gunshot injuries and require longer hospital stays.
The mean age of all individuals with firearm injuries was 27.5 years, and around 90% of them were men.
Nonfatal injury rates vary widely among California counties
The researchers mapped the county-level rates of nonfatal injury and found that incidents vary considerably among California counties.
In 2015, San Joaquin County had the highest nonfatal injury rate of 39.7 per 100,000 people - compared to Sonoma County’s 3.6 injuries per 100,000, the lowest in California. Around 48% of California’s 58 counties experienced a decrease in the rate of nonfatal firearm injury during the study period. The counties with the largest relative decrease in firearm injuries were Sonoma (73.8%) and Los Angeles (58.2%). Counties with rate increases tended to be in Northern California.
The study also found that urban counties had higher rates of firearm injury than rural counties.
Policy Implications
There are two possible general explanations for the increase in the fatality rate: the treatment of firearm injuries has not substantially improved over that period of time, or the treatment did get better, but the injuries got worse. While there is no indication that the severity of injuries got worse, there is a need for improved timely treatment of firearm injuries.
One possible approach is for first responders to adopt the “scoop and run” strategy -currently implemented in Philadelphia - to get the injured to a health care facility as fast as possible. Timely transport of the injured to the hospital is key in saving lives.
“This study advances our understanding of the incidence, distribution and lethality of firearm injuries in California,” said Garen Wintemute, emergency physician and director of the UC Davis Violence Prevention Research Program (VPRP) and the UC Firearm Violence Research Center (UCFC). “We hope other states will use this as a model to evaluate the burden of nonfatal firearm injuries as a basis for improved prevention efforts.”
