Children are safer in states with strict firearm laws: a National Inpatient Sample study

J Trauma Acute Care Surg. 2014 Jan;76(1):146-50; discussion 150-1. doi: 10.1097/TA.0b013e3182ab10fb.


Background: Firearm control laws vary across the United States and remain state specific. The aim of this study was to determine the relationship between variation in states' firearm control laws and the risk of firearm-related injuries in pediatric population. We hypothesized that strict firearm control laws impact the incidence of pediatric firearm injury.

Methods: All patients with trauma Ecodes and those 18 years or younger were identified from the 2009 Nationwide Inpatient Sample. Individual states' firearm control laws were evaluated and scored based on background checks on firearm sales, permit requirements, assault weapon and large-capacity magazine ban, mandatory child safety lock requirements, and regulations regarding firearms in college and workplaces. States were then dichotomized into strict firearm laws (SFLs) and non-strict firearm laws (non-SFLs) state based on median total score. The primary outcome measure was incidence of firearm injury. Data were compared between the two groups using simple linear regression analysis.

Results: A total of 60,224 pediatric patients with trauma-related injuries across 44 states were included. Thirty-three states were categorized as non-SFL and 11 as SFL. Two hundred eighty-six (0.5%) had firearm injuries, of which 31 were self-inflicted. Mean firearm injury rates per 1,000 trauma patients was higher in the non-SFL states (mean [SD]: SFL, 2.2 [1.6]; non-SFL, 5.9 [5.6]; p = 0. 001). Being in a non-SFL state increased the mean firearm injury rate by 3.75 (β coefficient, 3.75; 95% confidence interval, 0.25-7.25; p = 0.036).

Conclusion: Children living in states with strict firearm legislation are safer. Efforts to improve and standardize national firearm control laws are warranted.

Level of evidence: Prognostic study, level III.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Female
  • Firearms / legislation & jurisprudence*
  • Humans
  • Incidence
  • Male
  • Safety / statistics & numerical data
  • State Government
  • United States / epidemiology
  • Wounds, Gunshot / epidemiology*
  • Wounds, Gunshot / prevention & control