Pediatric firearm-related fatalities. Not just an urban problem
J. E. Svenson, C. Spurlock and M. Nypaver
Department of Emergency Medicine, University of Kentucky, Lexington, USA.
OBJECTIVE: To examine medical and demographic factors associated with the
firearm-related deaths among children in Kentucky. DESIGN: Retrospective
review and multiple regression analysis. DATA SOURCE: All firearm-related
deaths among children younger than 20 years reported to the Kentucky Office
of Vital Statistics, Frankfort, from 1988 to 1993. INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: All 320 pediatric firearm-related deaths
that occurred in Kentucky from 1988 to 1993 were analyzed. Death rates were
calculated for each county in the state. While the overall death rate from
firearms was not significantly different between African-American and white
children (relative risk [RR], 1.39; 95% confidence interval [CI],
0.98-1.98), the pattern of the types of events was markedly different.
African American children were much more likely to have been involved in a
homicide; suicides were more frequent in white children. Multiple Poisson
regression analysis, controlling for age, race, and gender, identified only
1 variable that was significantly associated with deaths due to firearms.
Children in rural Kentucky were at significantly more risk for a
firearm-related death than children in urban areas (RR, 1.26; 95% CI,
1.01-1.62) even after controlling for medical system variables
(availability of a hospital with 24-hour emergency services, availability
of prehospital advanced life support, and availability of 911 service).
CONCLUSIONS: Children in rural areas of Kentucky are at an increased risk
for firearm-related mortality. Prevention and intervention programs that
focus only on urban areas may not produce optimum results in the Kentucky
setting. Further research is needed to determine factors that are important
in rural areas so that interventions specific to them can be planned.
