Association of Legal Intervention Injuries With Race and Ethnicity Among Patients Treated in Emergency Departments in California

JAMA Netw Open. 2018 Sep 7;1(5):e182150. doi: 10.1001/jamanetworkopen.2018.2150.


Importance: Increased public concern regarding police use of force has coincided with a dearth of available data to uncover the magnitude and trends in injuries, particularly across race or ethnicity.

Objective: To examine trends in injury rates, severity, and disparities across black individuals, white individuals, Hispanic individuals, and Asian/Pacific Islander individuals.

Design, setting, and participants: In this retrospective, cross-sectional study, data collected on every hospital visit in California from January 1, 2005, to September 30, 2015, were used to model trends in rates of legal intervention injuries (n = 92 386) per capita and per arrest for men aged 14 to 64 years, by race or ethnicity. The study also examined descriptive statistics on injury dispositions to assess changes in severity. Analyses were conducted between December 2017 and June 2018.

Main outcomes and measures: All visits with an external cause of injury code of E970 to E977 were classified as legal intervention injuries. This range of codes includes injuries inflicted by the police or other law-enforcing agents in the course of arresting or attempting to arrest lawbreakers, suppressing disturbances, maintaining order, and other legal action.

Results: The study identified a total of 92 386 hospital visits that were the result of legal intervention among males aged 14 to 64 years. Black individuals were at the highest risk of legal intervention injury per capita in 2005 (for black vs white individuals, rate ratio, 2.90; 95% CI, 2.74-3.06), and remained so across the study period. Although rates among Asian/Pacific Islander individuals remained stable, rates in all other groups increased from 2005 to 2009 and then declined from 2009 to 2015, nearly returning to 2005 levels. During the period of increasing rates, the black to white disparity widened by 3% annually (rate ratio, 1.03; 95% CI, 1.01-1.05), then narrowed as rates declined. In contrast, rates of injury per arrest have increased over the past decade, although rates were broadly similar across race or ethnicity. The proportion of injuries involving firearms (ie, shootings by police) declined from 7.0% in 2005 and 2006 to 3.7% in 2014 and 2015.

Conclusions and relevance: States with central repositories for hospital visits offer data sources to illuminate the public health problem of legal intervention injuries, and warrant greater attention to ensure consistent coding for complete capture.

MeSH terms

  • Adolescent
  • Adult
  • California / epidemiology
  • California / ethnology
  • Cause of Death
  • Cohort Studies
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Police / standards
  • Police / statistics & numerical data*
  • Population Surveillance / methods
  • Public Health / standards
  • Public Health / statistics & numerical data
  • Racism / ethnology
  • Racism / statistics & numerical data*
  • Retrospective Studies
  • Wounds and Injuries / epidemiology
  • Wounds and Injuries / ethnology
  • Wounds and Injuries / etiology*