Citation

Nance ML, Carr BG, Kallan MJ, Branas CC, Wiebe DJ. Pediatrics 2010; 125(6): 1112-1118.

Affiliation

Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.

Copyright

(Copyright © 2010, American Academy of Pediatrics)

DOI

10.1542/peds.2009-3219

PMID

20498168

Abstract

Objective: We examined whether firearm mortality rates among children varied across US counties along a rural-urban continuum. Methods: US vital statistics data were accessed for all pediatric (age: 0-19 years) firearm deaths from 1999 through 2006. Deaths were analyzed according to a modified rural-urban continuum code (based on population size and proximity to metropolitan areas) assigned to each county (3141 counties). Results: In the 8-year study period, there were 23 649 pediatric firearm deaths (15 190 homicides, 7082 suicides, and 1377 unintentional deaths). Pediatric nonfirearm mortality rates were significantly higher in the most-rural counties (adjusted rate ratio: 1.36 95% confidence interval CI.: 1.13-1.64.), compared with the most-urban counties. The most-rural counties demonstrated virtually identical pediatric firearm mortality rates (adjusted rate ratio: 0.91 95% CI: 0.63-1.32.), compared with the most-urban counties. The most-rural counties had higher rates of pediatric firearm suicide (adjusted rate ratio: 2.01 95% CI: 1.43-2.83.) and unintentional firearm death (adjusted rate ratio: 2.19 95% CI: 1.27-3.77.), compared with the most-urban counties. Pediatric firearm homicides rates were significantly higher in the most-urban counties (adjusted rate ratio: 3.69 95% CI: 2.00-6.80.), compared with the most-rural counties. Conclusions: Children in the most-rural US counties had firearm mortality rates that were statistically indistinguishable from those for children in the most-urban counties. This finding reflects a greater homicide rate in urban counties counterbalanced by greater suicide and unintentional firearm death rates in rural counties. Nonfirearm mortality rates were significantly greater outside the most-urban US counties.

Language: en