National trends in nonfatal firearm-related injuries compared to deaths: Are firearm-related injury rates on the rise? J. Lee Annest, PhD Tad Haileyesus, MS Jim Mercy, PhD George Ryan, PhD Robin Ikeda, MD, MPH National Center for Injury Prevention and Control Coordinating Center for Environmental Health and Injury Prevention Centers for Disease Control and Prevention November 6, 2007 lannest@cdc.gov

Acknowledgments Tom Schroeder, MS, Director Cathy Irish, and Others Division of Hazard and Injury Data Systems, CPSC for operating NEISS and collecting these data Disclaimer: The findings and conclusions in this presentation are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Outline Background on data sources Trend data (preliminary data) Summary and conclusions

National Data Sources National Electronic Injury Surveillance System, CPSC – Nonfatal Firearm Injuries Uniform Crime Reports-Supplemental Homicide Data, FBI – [police reports] – Homicides National Vital Statistics Data System, NCHS – [death certificates]– Firearm Homicides

National Electronic Injury Surveillance System (NEISS) Operated by the U.S. Consumer Product Safety Commission (CPSC) Started October, 1978 Nationally representative sample of U.S. hospitals with > 6 beds and an ED First time, injury-related visits

Components of NEISS Ongoing ED surveillance Special studies – CDC Firearm Injury Surveillance Study, started in 1993 Follow-up investigations

Ongoing ED Surveillance Sampling frame updated every 10 years (last update 1997) # of NEISS hospitals varied over time (low-62; high-101) Captures 330,000 consumer product-related injuries annually – approx. 2,300 nonfatal firearm injuries/year Core Variables (age, sex, race/ethnicity of patient, two-product codes, primary body part affected, principal diagnosis, locale of injury incident, disposition, narrative) Special Study Variables (intent, type of firearm, mode of transport to ED, other circumstance variables)

99 NEISS Hospitals, 2001 Very Large Hospitals Large Hospitals Meriden, CT Brooklyn, NY Staten Island, NY Bronx, NY Patchogue, NY Freehold, NJ Atlantic City, NJ Brighton, NJ Very Large Hospitals Large Hospitals Medium Hospitals Small Hospitals Children’s Hospitals Data Source: U.S. CPSC

1997 NEISS Sample Design Stratum Total ERVs US Hospitals NEISS sample 1 1-16,830 3,179 46 2 16,831-28,150 1,059 13 3 28,151-41,130 674 9 4 41,131+ 426 23 Children’s Various 50 8 ------------------------------------------------------------------------------ Total 5,388 99

Data sources: NVSS for deaths; NEISS for nonfatal injuries

Data sources: NVSS for deaths; NEISS for nonfatal injuries

Firearm Homicide Rate* Change among Males Age Group Year 1993 2004 % Decline 15-19 yrs 30.5 13.1 - 57.0 20-24 yrs 36.8 21.5 - 41.6 25-29 yrs 23.9 18.8 - 21.3 * Rate per 100,000 population Data source: NVSS

Nonfatal Assault-Related Firearm Injury Rate* Change among Males Age Group Year 1993 2004 % Decline 15-19 yrs 165.5 63.6 - 61.6 20-24 yrs 152.6 88.3 - 42.1 25-29 yrs 89.5 71.9 - 19.7 * Rate per 100,000 population Data source: NEISS

FBI-SHR Data From 2004 to 2005, homicides up 3.4% and violent crimes up 2.3% Is it indicating the start of a new upward trend in firearm assault rates?

Data sources: FBI UCR-SHR

Data sources: FBI UCR-SHR

Data Sources: NVSS for deaths, NEISS for nonfatal Injuries

Data source: NEISS

Data source: NEISS

Data source: NEISS

Data Source: NEISS

Data Source: NEISS

Data Source: NEISS

Data Source: NEISS

Data Source: NEISS

Summary of findings FBI Supplemental Homicide data indicate a 6.0% rise in firearm homicides from 2002-2005 (mostly from 2004 to 2005). NEISS data on nonfatal assault-related firearm injuries indicate: 50% decline injuries from 1993 to 2002 followed by 37% increase from 2002 to 2005. NEISS data indicate that nonfatal injuries associated with other means of assaults (e.g., stab/cut, struck by/against) remained relatively unchanged

Possible Explanations Assaults involving firearm-related injuries are increasing recently but are less lethal. Assaults involving firearm-related injuries are increasing recently but more of those being shot might be surviving due to improved EMS and emergency medical care services.

Conclusions National estimates of nonfatal assault-related firearm injuries treated in US hospital EDs increased from 2002 to 2005 There may be an increase in firearm homicides to follow These results demonstrate the potential usefulness of NEISS as an early indicator of changing trends in violence-related injuries involving weapons.