Reviewed by
Zalman
S. Agus, MD; Emeritus Professor, Perelman School of
Medicine at the University of Pennsylvania
- Note that this study was published as an
abstract and presented at a conference. These
data and conclusions should be considered to be
preliminary until published in a peer-reviewed
journal.
ORLANDO -- The combination of children and guns in the
same household contributed to a steady rise in gunshot
wounds and deaths in children, according to a review of
national data over a 12-year period.
The number of children hospitalized for gunshot wounds
increased from 4,270 in 1997 to 7,730 in 2009. In-hospital
deaths among pediatric gunshot patients increased from 317
to 503 over the same period.
Among gunshot wounds with known incident locations, 40%
of the wounds occurred in the child's home. The data
showed a significant association between gunshot wounds to
children and the presence of one or more guns in the
household. The association grew stronger when unsafe gun
storage was included in the analysis (P=0.02 to P<0.01),
although some of the numbers were small.
"Handguns are responsible for most of the childhood
gunshot wounds," Arin L. Madenci, MD, of the University of
Michigan in Ann Arbor, said here at the
American Academy of Pediatrics
meeting. "Increasing household gun ownership correlated
with increasing childhood gunshot wounds. There was a
stronger likelihood of home gunshot wounds with unsafe
storage practices."
Approximately 2,700 children die of gunshot wounds each
year. Precise data on the epidemiology of childhood
gunshot wounds are difficult to find, in part, because of
limitations in the CDC budget, which includes about
$100,000 (of a $6 billion total) for the study of
gun-related issues, he said.
According to the
Children's Defense Fund, the rate of
gun-related deaths among children and teenagers in the
United States is 3.24 per 100,000. That rate is 17 times
greater than the rates of 25 other developed nations
combined, said Madenci.
The U.S. has the highest gun ownership per capita in the
world (nine guns for every 10 people). Gun-related
homicides involving children more than tripled from 1960
to 2010, he continued.
Given the trends in gun ownership and childhood deaths
attributable to gunshot wounds, Madenci and
Christopher B. Weldon, MD, PhD, of
Boston Children's Hospital and Harvard, hypothesized that
household gun ownership would correlate with childhood
gunshot wounds.
Over the course of the study period, 31,156 children were
hospitalized for gunshot wounds and 2,159 children died in
hospital of gunshot wounds.
For the proportion of hospitalizations with a known type
of gun, handguns accounted for 77%, shotguns for 19%, and
hunting or military rifles for 4%.
Focusing on the 40% of gunshot wounds that occurred in
homes, Madenci and Weldon examined the relationship
between the presence of a gun in the home and at-home
gunshot wounds involving children. They also identified
the proportion of households with loaded guns and the
proportion with loaded guns in unlocked storage.
The investigators performed regression analysis to
determine the relationship between the percentage of
households with guns and the percentage of childhood
gunshot wounds. Specifically, they calculated the percent
change (up or down) in childhood gunshot wounds that would
be expected with a 1% change in households with guns. The
resulting beta regression coefficient reflected the
change.
Across the 50 states, the proportion of households with
children and at least one gun ranged from 10% to 62%. The
proportion with loaded guns ranged from 1% to 14%, and the
proportion with loaded guns in unlocked storage from
<1% to 7%. Comparing the household gun-related data and
childhood gunshot wounds showed significant associations
for all comparisons:
- Any gun - beta=0.7, 95% CI 0.3-1.1, P<0.01
- Loaded gun - beta=1.7, 95% CI 0.3-3.2, P=0.02
- Loaded gun in unlocked storage - beta=2.9, 95% CI
0.6-5.2, P=0.02
An analysis of the relationship between the percentage of
gunshot wounds occurring in the home and the proportion of
households with a gun and children produced beta values of
0.7 for any gun (P<0.01), 2.1 for loaded
firearms (P=0.04), and 4.8 for loaded firearms in
unlocked storage (P=0.01).
The study provided more detailed information about trends
in firearm injuries involving children than has been
available in the past, said
David Hemenway, PhD, of the Harvard
School of Public Health.
"The results are consistent with a number of other
studies which have found that where there are more guns,
particularly guns in the home, it's more likely that there
will be danger for children," Hemenway told MedPage
Today.
"Also, how you store the gun makes a difference. Storing
the gun unsafely increases the danger for both accidents
and suicide to children 1 to 17 years of age."
The data suggest actions that healthcare providers can
take to help reduce the number of children injured and
killed by guns each year.
"The study suggests, consistent with other studies, that
physicians should talk to patients, particularly parents,
about guns in the home, so they can weigh the risks and
benefits of having a gun in the home and also talk to
patients about how to store a gun," said Hemenway.