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Research: 550,000+ Firearm-Related Hospitalizations 2000-2016

Posted by Warm Southern Breeze on Wednesday, May 5, 2021

States in the Deep South lead the nation in average per capita firearm-related hospitalizations.

Average Firearm Injury Hospitalization Rate per 100,000, 2000–2016

1.) Louisiana – 24
2.) Tennessee – 18
3.) Alabama – 16
4.) Missouri – 16
5.) Maryland – 16
6.) Michigan – 14
7.) Illinois – 13
8.) North Carolina – 13
9.) South Carolina – 13
10.) Mississippi – 13
11.) Arizona – 13
12.) Arkansas – 12
13.) Delaware – 12
14.) Pennsylvania – 12
15.) Nevada – 12
16.) California – 12
17.) Oklahoma – 11
18.) Texas – 10
19.) Kansas – 10
20.) Indiana – 10
21.) Ohio – 10
22.) Kentucky – 9
23.) Virginia – 8

The national average is 10.

Ongoing and recently updated research by the RAND Corporation – a nonprofit, nonpartisan, research organization working in the public interest to develop solutions to public policy challenges to improve communities nationally, and worldwide by making them healthier, and more prosperous, safer, and more secure – showed that nationally:

“In 2018, 39,740 individuals in the United States were killed by firearms, making firearm violence the second leading cause of injury death in the United States (Centers for Disease Control and Prevention [CDC], undated).

“As part of the Gun Policy in America initiative, RAND researchers developed a longitudinal database of state-level estimates of inpatient hospitalizations for firearm injury between 2000 and 2016. This database was first released in 2021 and is free to the public.

RAND researcher Dr. Andrew Morral, PhD who is the Senior Behavioral Scientist, and Director of the National Collaborative on Gun Violence Research there, tweeted recently (April 28) that:

“Why are firearm hospitalizations not correlated with gun ownership in observed state hospitalization data or our estimates? Because they chiefly result from criminal assaults (vs. suicides) and these are not correlated with household gun ownership.”

This type of research is a phenomenally difficult proposition, and highly complicated undertaking, and the entirety of the paper is spent detailing and explaining their methodology, and sources, because not every state provides information to, or participates in HCUP, the Healthcare Cost and Utilization Project.

As well, data had to be compared and cross-referenced with other similarly related databases, such as the FBI’s annual UCR – Uniform Crime Report.

And then, they get into the math – the statistical analysis – and explain the formulae used, which then has to be checked with other external mathematical models to determine, and ensure a high level of accuracy. In short, this is not “relaxing reading” by any stretch of the imagination – it is highly technical explanations of phenomenally difficult work, which only indirectly points to the significance of their findings.

HCUP is the Nation’s most comprehensive source of hospital care data, including information on in-patient stays, ambulatory surgery and services visits, and emergency department encounters. HCUP enables​ researchers, insurers, policymakers and others to study health care delivery and patient outcomes over time, and at the national, regional, State, and community levels. HCUP is part of the Agency for Healthcare Research and Quality, in Rockville, MD, under the aegis of U.S. Department of Health & Human Services.

Data for the states of Alabama, Alaska, Connecticut, Delaware, Georgia, Idaho, Louisiana, Mississippi, Montana, Ohio, Pennsylvania, South Dakota, and Virginia are missing from HCUPnet.

However, there are alternative methods to obtain and study such information, and the researchers acknowledge the difficulty of their undertaking by writing that, “because the available covariates are strongly associated with the firearm hospitalization rate, the model can estimate the missing information with a relatively high degree of precision.” As the saying goes, “there’s more than one way to skin a cat.”

Another difficulty in conducting the research was the change from ICD-9 to ICD-10. The International Classification of Diseases is a coding system that “provides a common vocabulary for recording, reporting and monitoring health problems.”

“The International Statistical Classification of Diseases and Related Health Problems (ICD) is the bedrock for health statistics. It maps the human condition from birth to death: any injury or disease we encounter in life − and anything we might die of − is coded.

“The ICD also captures factors influencing health, or external causes of mortality and morbidity, providing a holistic look at every aspect of life that can affect health.”

It also establishes a uniform base which all healthcare professionals and researchers use – including health insurance companies.

This most recent work has shortcomings, however, and the researchers acknowledge that “these data do not capture the full scope of firearm-related morbidity (i.e., our measures do not capture emergency department visits for firearm injuries that do not result in subsequent hospitalization, nor do they capture individuals with gunshot wounds who do not obtain medical care).”

Again, in the final discussion of the findings, the researchers summarize what they did, their method, and the potential use it may provide, by writing that:

“This project provides estimates of annual inpatient hospitalizations for gunshot injury for all 50 states between 2000 and 2016. We impute firearm hospitalization rates for the many state-years with missing data and also debias available raw data to the extent that there are injuries recorded in each state-year without information regarding whether the injury mechanism involved a firearm.

“These estimates can also be useful for calculating the total cost or social burden of firearm injury at the national or state level, although it is important to note that our estimates reflect inpatient hospitalization for firearm injury and thus do not capture the full scope of firearm-related morbidity (i.e., our measures do not capture ED visits for firearm injuries that do not result in subsequent hospitalization, nor do they capture individuals with gunshot wounds who do not obtain medical care).

“Our measures provide more-accurate estimates of firearm injuries resulting in hospitalization (including incidents admitted through an ED), which are likely to capture the most-serious and -costly nonfatal firearm injury incidents.”​

Again, in the discussion, they acknowledge that “some users might wish to combine hospitalization and vital statistics mortality data to assess the rate of individuals who either were hospitalized or died from firearm injuries.”  Yet they also point out that events in the above-cited example, “are not, however, independent outcomes. Specifically, some fraction of hospitalized individuals died from their injuries and the same individual can thus be counted in both data sets.”

Again, that points to the pure difficulty of their undertaking, and the enormity of the task, which also makes the findings all the more significant.

​And again, they point to the difficulty presented when an injury occurs in one state, but is transferred to another for treatment –or– may be initially hospitalized in the same state as the injury occurred, but later transferred to another out-of-state hospital, by writing that:

“A common feature of state data on inpatient hospitalizations is that they exclude individuals who were injured within the state but were treated in another state (i.e., the data represent injuries treated in the state rather than injuries inflicted in the state).”​

The researchers also identify shortcomings in the system as it now exists, and the difficulties it causes for researchers, and they offer some recommendations for improvement to the same.

“In this project, we generated estimates of firearm injury hospitalizations because these data are not reliably recorded and made available in all states. In the ideal, all states would record and publicly report hospitalization data in sufficient detail such that the data could be used to examine research questions concerning firearm hospitalizations. Short of this, there might be ways that existing data sets could be shared to improve research on firearm injuries. Small improvements to data services like HCUPnet could make the data that such services provide much more useful for firearm policy researchers.”


550,000 Hospitalized From Gun Injuries Between 2000 And 2016, Research Shows

by Celine Castronuovo, Staff Writer
05/04/21 12:25 PM EDT

More than half a million people were hospitalized as a result of gun injuries from 2000 to 2016, according to a new study published Tuesday by California-based think tank the RAND Corporation.

The report, part of the group’s Gun Policy in America initiative to measure the impacts of firearm legislation, found that based on data available on gun injuries, roughly 550,000 people were treated for gunshot wounds at hospitals over the 16-year period.

While the think tank noted that the information on nationwide gunshot wound hospitalizations is limited, because there is no comprehensive national database of gunshot injuries, Tuesday’s report follows previous studies indicating that a substantial amount of health care funds are being spent to treat victims of gun violence.

Each year, approximately $2.8 billion of health care spending is devoted to gun-related hospital visits, according to a 2017 study published in the Health Affairs journal.

The data, drawn from State Inpatient Databases and other state health department data, showed that from 2000 to 2016, the most firearm injuries that required hospitalization occurred in Louisiana, where there was an injury hospitalization rate of 24 per 100,000 residents each year.

Louisiana was followed by Tennessee with an annual rate of 18 per 100,000, with Missouri, Alabama and Maryland tied for third at a rate of 16 per 100,000.

The national rate of firearm injury hospitalizations remained relatively constant from 2000 to 2016, with an annual high of about 10 hospitalizations resulting from gunshot wounds per 100,000 people.

The findings come amid a reignited debate over gun control legislation in response to a wave of deadly mass shootings that have rocked the nation in recent months, including the March attack in Boulder, Colorado, that left 10 people dead, including an on-duty police officer, as well as April’s mass shooting at an Indianapolis, Indiana FedEx facility that left nine people dead, including the gunman.

President Biden has called on Congress to pass a Federal ban on assault weapons and high-capacity magazines, which he reiterated last week during his first address to a joint session of Congress.

“We need a ban on assault weapons and high capacity again. Don’t tell me it can’t be done. We did it before and it worked,” Biden said, referring to the 10-year ban on assault weapons passed in 1994 while he served in the Senate.

Biden has also urged Senate Republicans to back House-passed bills that would strengthen background checks and close the so-called Charleston loophole by extending the time Federal investigators have to conduct background checks.

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