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Geographic Variation in Serious Nonfatal Firearm Injuries in Pennsylvania

Sing, Ronald F. DO; Branas, Charles C. PhD; MacKenzie, Ellen J. PhD; Schwab, C. William MD

Journal of Trauma and Acute Care Surgery: November 1997 - Volume 43 - Issue 5 - p 825-830

Objective  The purpose of this study was to characterize the geographic epidemiology of serious nonfatal firearm injuries (NFFI) within Pennsylvania during a 6-year period.

Methods  A historical review of data from the Pennsylvania Trauma System Foundation trauma registry was completed using county-level data. Based on a format adapted from the United States Department of Agriculture, NFFI in Pennsylvania were classified by their county of occurrence: central city counties, metropolitan counties, nonmetropolitan counties, or rural counties. Population-based rates of NFFI were then calculated, as were NFFI as a proportion of the number of injuries within each region. These rates were stratified by intent of injury, scene of injury, and type of firearm.

Results  A total of 100,703 trauma cases were reported to the Pennsylvania Trauma System Foundation from 1988 through 1993, of which 5,847 were serious NFFI. Nonfatal firearm assaults increased from rural counties to central city counties, whereas unintentional NFFI decreased (p < 0.05). A 225% increase in the number of NFFI, from 445 cases in 1988 to 1,004 cases in 1993, was noted in the central city counties. Comparatively, the increase in the noncity regions was 145%, from 182 cases in 1988 to 263 in 1993. Nonfatal firearm injuries occurred most often at home in noncity counties (rural, nonmetropolitan, and metropolitan counties) (47.9%). This is in contrast to central city counties, where NFFI occurred significantly more often in the street (53.5%) (p < 0.05). Handgun NFFI increased, whereas rifle NFFI decreased, from rural counties to central city counties (p < 0.05). Relative to population size, the risk of shotgun injuries was greatest in central city counties and lowest in rural counties. Shotgun injuries also accounted for a significantly longer hospital stay (15.06 days) compared with handgun injuries (10.38 days) and rifle injuries (11.81 days) (p < 0.05).

Conclusion  Significant variation in NFFI was observed across population-based regions in Pennsylvania. Rural areas demonstrated relatively high risks of NFFI committed unintentionally, in the home, and with rifles. As regional populations increase, relatively high risks of NFFI, committed as assaults, in the street, and by handguns, are highlighted. Although handguns were the most prominent firearm associated with NFFI, nonfatal shotgun injuries produced substantially longer hospital stays and may be an underappreciated cause of nonfatal firearm assaults in the urban setting.

From the Department of Surgery (R.F.S.), Carolinas Medical Center, Charlotte, North Carolina; the Johns Hopkins School of Hygiene and Public Health (C.C.B., E.J.M.), Baltimore, Maryland; and the Division of Trauma and Surgical Critical Care (C.W.S.), University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.

Address for reprints: Ronald F. Sing, DO, Department of Surgery, Carolinas Medical Center, 1000 Blythe Boulevard, MEB 6, Charlotte, NC 28203; e-mail:

© Williams & Wilkins 1997. All Rights Reserved.