1. 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

2. 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.

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

4. 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

5. 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

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

7. 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)

8. 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

9. 1997 NEISS Sample Design Stratum Total ERVs US Hospitals NEISS sample
, ,
,831-28, ,
,151-41, ,
Children’s Various
Total ,

10. Data sources: NVSS for deaths; NEISS for nonfatal injuries

11. Data sources: NVSS for deaths; NEISS for nonfatal injuries

12. Firearm Homicide Rate* Change among Males
Age Group
Year %
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

13. Nonfatal Assault-Related Firearm Injury Rate* Change among Males
Age Group
Year %
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

14. 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?

15. Data sources: FBI UCR-SHR

16. Data sources: FBI UCR-SHR

18. Data Sources: NVSS for deaths, NEISS for nonfatal Injuries

19. Data source: NEISS

20. Data source: NEISS

21. Data source: NEISS

22. Data Source: NEISS

23. Data Source: NEISS

24. Data Source: NEISS

25. Data Source: NEISS

26. Data Source: NEISS

27. Summary of findings
FBI Supplemental Homicide data indicate a 6.0% rise in firearm homicides from (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

28. 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.

31. 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.