Lethality of firearm-related injuries in the United States population

Study objective: To characterize differences in the lethality of firearm-related injuries in selected demographic subgroups using national representative data on fatal and nonfatal firearm-related injuries. We also characterize the lethality of firearm-related injuries by intent of injury and anatomic location of the gunshot wound. Methods: We analyzed case-fatality rates (CFRs) of firearm-related injuries in the United States by using death data from the National Vital Statistics System and data on nonfatal injuries treated in US hospital emergency departments from the National Electronic Injury Surveillance System. National estimates of crude and age-adjusted CFRs are presented by sex, race/ethnicity, age, intent, and primary body part affected. Results: Each year during the study period (July 1992 through December 1995), an estimated 132,687 persons sustained gunshot wounds that resulted in death or treatment in an ED. The overall age-adjusted CFR among persons who sustained firearm-related injuries was 31.7% (95% confidence interval [CI] 27.7 to 35.6). The age-adjusted CFR for persons who were alive when they arrived for treatment in an ED (11.3%; 95% CI 9.4 to 13.2) was about one third as large as the overall CFR. The age-adjusted CFR Varied by sex, race/ethnicity, and age, but these differences depended an intent of injury. For assaultive injuries, the age-adjusted CFR was 1.4 times higher for females (28.7%) than males (20.6%). For intentionally self-inflicted injuries, the age-adjusted CFR was 1.1 higher for males (77.7%) than females (69.1%). For assaults, the age-adjusted CFR was 1.5 times higher for whites (29.5%) than blacks (19.2%). For assaultive and intentionally self-inflicted injuries among persons 15 years and older the age-specific CFR increased with age. Persons shot in the head (age-adjusted CFR, 61.0%) were 3.3 times as likely to die as those shot in other body parts (age-adjusted CFR, 18.7%). Conclusion: The lethality of firearm-related injuries was influenced strongly by the intent of injury and body part affected. The high lethality of firearm-related injuries relative to other major causes of injury emphasizes the need to continue prevention efforts and efforts to improve access to care and treatment (including emergency medical and acute care services) to reduce the number and increase survivability of firearm-related injuries.