Randi N Smith, MD, MPH1, Elizabeth D Rose, MD2, Analise Mcgreal3, Brett Tracy, MD1, Samy Bendjemil, MD, MPH4, Mara Schenker, MD5, Peter Rhee, MD, MPH6. 1Emory University School of Medicine, Department of Surgery, 2Dwight D. Eisenhower Army Medical Center, 3Mercer University School of Medicine, 4Rush Unversity School of Medicine, 5Emory University School of Medicine, Department of Orthopedic Surgery, 6Grady Memorial Hospital
INTRODUCTION: Over 70,000 Americans sustain injuries from gunshot wounds each year; nearly 40,000 more die from homicide by firearms. There is a paucity of data investigating the root causes of gun violence in communities with high gun violence rates. We hypothesize that areas of economic duress will have higher rates of firearm injury.
METHODS AND PROCEDURES: We performed a cross-sectional analysis of nonfatal gunshot victims at an urban Level 1 Trauma Center over a 4 month period in 2018. Patient demographics, circumstances and mechanisms of injury, and clinical outcomes were recorded. Zip code of patient residence and zip code at the location of injury were used to calculate the Distressed Communities Index (DCI). The DCI is a national metric of economic distress at the community level, determined by seven independent but linked variables – unemployment, poverty, vagrancy, median income, education, change in employment and turnover in business. Based off DCI scores, communities are grouped into 1 of 5 tiers – prosperous (<40), comfortable (40-59), mid-tier (60-69), at risk (70-79) or distressed (>80).
RESULTS: During the study period,186 patients sustained gunshot wounds, of which, 79 were included in the analysis. Most patients were black 89.9% (n=71), male 89.6% (n=60) with a median age of 29 years [Q1:19y-Q3:68y]. Patients presented with an average of 2.63 missile wounds with the most affected body region being the lower extremities. Intentional injuries accounted for 76% (n=60) with 42% (n=25) of these events related to interpersonal altercations and 36% (n=22) related to robberies. 28 (35%) lived in areas of distressed zip codes, and 19 (24%) lived in at risk communities. 24 (30%) of the incidents occurred in distressed areas, 15 (19%) occurred in at risk areas, however, 28 (35%) injury zip codes were unknown. Only 3 (4%) were injured in areas with improved DCI. Twenty-five percent (N=20) of the incidents occurred in locations with higher DCIs than home.
CONCLUSIONS: Economic disparities exists and the majority of individuals with gunshot wounds reside in economically distressed communities (high DCIs). Better understanding of the social and economic context of gunshot wounds is prudent to developing and implementing effective and appropriate prevention strategies.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94526
Program Number: P634
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster