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Article 1
Geospatial mapping can be used to identify geographic areas and social factors associated with intentional injury as targets for prevention efforts distinct to a given community. Lasecki CH, Mujica FC, Stutsman S, Williams AY, Ding L, Simmons JD, Brevard SB. J Trauma Acute Care Surg. 2018 Jan;84(1):70-74.
This study used a 10-year period at a single center and extracted all intentional interpersonal injuries from the trauma registry. They then used the street address of the incident to enter data into ArCGIS software and create a kernel density map of incidents and identify spatial clustering. They then overlaid the socioeconomic data of the census blocks in the catchment area and identified the strength of association to several factors, such as race, income, population density, unemployment, and other social factors. The results of the study demonstrated 3 factors related to injury in communities: unemployment, single-parent households, and lack of high school degree.
Contrary to most clinical studies in the trauma population, in which multicenter is better than single center, these single center studies of geospatial risk and injury prevention may be satisfactory to inform replication nationwide for local use. High fidelity injury prevention programs should be designed to be sensitive to the culture of the local community, therefore, a study such as this one may be less valuable for the portability of the findings and more valuable as providing a roadmap for other centers to replicate it using their findings. Individual centers can then learn about their own community factors from replicating these studies. For example, this study found that alcohol-serving establishments and liquor stores were not significantly associated with injury, contrary to many other studies in urban health. This gives insight into unique factors in this locality.
The idea of measuring place-based effects on injury prevention, and specifically, the social determinants of injury, gained traction in the early 2000s as studies found that, for instance, children of unemployed patients are 13 times more likely to die of injury. The complex, contextual relationships that exist within geospatial relationships, beyond simple compositional models of geospatial risk, are increasingly apparent. As such, injury prevention work has increasingly relied on the social and behavioral sciences for understanding what makes spaces risky, and how to enact behavior change to mitigate risk. GIS has increased the analytic power in injury prevention work by allowing complex special analysis techniques, beyond traditional "heat mapping." Evidence from such studies can fuel new ideas for injury prevention, including modifications to the built environment or social and behavioral directed programming to individuals living in or interacting within high-risk environments.
Article 2
Circumstances surrounding gun violence with youths in an urban setting. Borg BA, Krouse CB, McLeod JS, Shanti CM, Donoghue L. J Pediatr Surg. 2020 Jul;55(7):1234-1237.
This is a retrospective review of pediatric patients aged 0 to 18 who presented with gunshot wounds to any of the three hospitals affiliated with a single institution in a major US city between 2013 and 2017. The three hospitals include an ACS-verified level 1 pediatric trauma center, a level 1 adult trauma center and a level 2 adult trauma center. Over 300 patients were identified and subsequently divided into three age categories: age 0-7 years, 8-14 years and 15-18 years. Multiple variables including age, race, gender, zip-code, type of firearm, circumstances surrounding the firearm-related injury, location of the shooting, shooter and mortality were collected. The aim of the study was to learn about the circumstances surrounding the shootings involving pediatric patients in order to target injury prevention strategies appropriately.
Among all age categories, drive-by shootings were the most commonly known circumstance related to firearm-related injury at 47%. Among the youngest age group, drive-by shootings made up 54% of known circumstances related to firearm injury. Unlocked guns made up the second largest group with the highest percentage of injuries among children aged 8-14 (26%). Suicide made up less than 5% of all firearm-related deaths in all age categories. A heatmap was generated using zip-code data resulting in the identification of 8 zip-codes at high risk of drive-by shootings. Overall mortality was 6%.
Identification of high-risk zones for drive-by shootings may allow for system-focused interventions and collaboration with law enforcement and community partners. Further stratification of data by zip code, age and circumstances surrounding firearm-related injury offers an opportunity for targeted injury prevention programs.
Article 3
Changes in US mass shooting deaths associated with the 1994-2004 federal assault weapons ban: Analysis of open-source data. DiMaggio C, Avraham J, Berry C, Bukur M, Feldman J, Klein M, Shah N, Tandon M, Frangos S. J Trauma Acute Care Surg. 2019 Jan;86(1):11-19.
This is an observational epidemiologic study designed to evaluate whether the US federal assault weapons ban (AWB) of 1994, which lasted for 10 years, was associated with a decrease in mass shooting deaths during the ban period. The authors gathered open source data from 3 public registries (Mother Jones Magazine, the LA Times and Stanford University), identified incidents reported by all 3 sources and including at least 4 fatalities not including the shooter, and divided the data into 3 time frames: pre-ban, ban, and post-ban. The authors also gathered yearly homicide data from the US CDC WISQARS database of fatal and non-fatal injury and calculated the annual rate of mass-shootings per 10,000 firearm homicide deaths.
There were 44 incidents between 1981 and 2017 which met criteria for mass-shootings, of which 34 (77%) involved assault weapons, accounting for 430 (85%) of the 501 mass-shooting fatalities during the study period. The authors found that between 1981 and 2017 mass shootings accounted for an increasing proportion of all firearm related homicides; however, the rate of increase slowed during the AWB period and increased in the post-ban period. They found a similar trend when evaluating only those deaths related to mass shooting incidents involved assault weapons. Controlling for yearly trend, the AWB period was associated with a statistically significant 9 fewer mass shooting deaths per 10,000 firearm homicides per year. The calculated risk ratio for the association of the federal ban period with mass-shooting fatalities as a proportion of all firearm-related homicides was 0.29, indicating that mass shooting fatalities were 70% less likely to occur during the federal ban period. The authors extrapolate that the ban would have prevented 314 of the 448 mass shooting deaths during the non-ban periods. It is important to note that the 501-mass shooting related deaths account for a very small fraction (0.1%) of the 489,043 firearm-related homicides in the US during the study period and that suicides account for ~60% of all firearm related deaths in the US; accordingly the rate of overall firearm-related deaths are not likely to be significantly affected by re-institution of a federal AWB. While this study shows that re-institution of the AWB would likely prevent a significant number of mass shooting fatalities, it is only one part of what must be a multi-pronged approach to decrease gun violence in the US.
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