Firearm-related hospitalization and risk for subsequent violent injury, death, or crime perpetration: a cohort study

Ann Intern Med. 2015 Apr 7;162(7):492-500. doi: 10.7326/M14-2362.


Background: Risk for violent victimization or crime perpetration after firearm-related hospitalization (FRH) must be determined to inform the need for future interventions.

Objective: To compare the risk for subsequent violent injury, death, or crime perpetration among patients with an FRH, those hospitalized for noninjury reasons, and the general population.

Design: Retrospective cohort study.

Setting: All hospitals in Washington.

Patients: Patients with an FRH and a random sample of those with a non-injury-related hospitalization in 2006 to 2007 (index hospitalization).

Measurements: Primary outcomes included subsequent FRH, firearm-related death, and the combined outcome of firearm- or violence-related arrest ascertained through 2011.

Results: Among patients with an index FRH (n = 613), rates of subsequent FRH, firearm-related death, and firearm- or violence-related arrest were 329 (95% CI, 142 to 649), 100 (CI, 21 to 293), and 4221 (CI, 3352 to 5246) per 100 000 person-years, respectively. Compared with the general population, standardized incidence ratios among patients with an index FRH were 30.1 (CI, 14.9 to 61.0) for a subsequent FRH and 7.3 (CI, 2.4 to 22.9) for firearm-related death. In survival analyses that accounted for competing risks, patients with an index FRH were at greater risk for subsequent FRH (subhazard ratio [sHR], 21.2 [CI, 7.0 to 64.0]), firearm-related death (sHR, 4.3 [CI, 1.3 to 14.1]), and firearm- or violence-related arrest (sHR, 2.7 [CI, 2.0 to 3.5]) than those with a non-injury-related index hospitalization.

Limitation: Lack of information on whether patients continued to reside in Washington during follow-up may have introduced outcome misclassification.

Conclusion: Hospitalization for a firearm-related injury is associated with a heightened risk for subsequent violent victimization or crime perpetration. Further research at the intersection of clinical care, the criminal justice system, and public health to evaluate the effectiveness of interventions delivered to survivors of firearm-related injury is warranted.

Primary funding source: Seattle City Council and University of Washington Royalty Research Fund.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Crime*
  • Female
  • Firearms
  • Hospitalization*
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Violence
  • Washington / epidemiology
  • Wounds, Gunshot / epidemiology*
  • Wounds, Gunshot / mortality
  • Young Adult