Urban areas have higher overall pediatric hospitalization rates for firearm injuries, with the highest rates for urban 15- to 19-year-olds, according to a study published online July 2 in Pediatrics

Bradley R. Herrin, M.D., from Yale University in New Haven, Conn., and colleagues examined how hospitalization rates for firearm injuries differ for rural and urban populations. Hospitalizations for firearm injuries were identified using the Kids' Inpatient Database. Data were analyzed from 2006, 2009, and 2012 to compare demographics and intent.

The researchers identified 21,581 hospitalizations for firearm injuries. Urban areas have a higher overall hospitalization rate than rural areas (risk ratio, 1.95). The highest rates were seen for assaults in urban 15- to 19-year-olds (risk ratio, 7.82).

The Kids’ Inpatient Database was used to identify hospitalizations for firearm injuries in patients <20 years of age by using International Classification of Diseases, Ninth Revision external-cause-of-injury codes. Data from 2006, 2009, and 2012 were analyzed to compare demographics and intent (assault, self-inflicted, unintentional, and undetermined).

The urban-rural classification was based on patients' county of residence

In younger age groups, unintentional injuries were the leading cause of hospitalizations in all urban and rural locations. Unintentional injury rates were lower for urban versus rural 5- to 9-year-olds and 10-to-14-year-olds (risk ratios, 0.47 and 0.44, respectively).

Rates were highest for assaults in urban 15- to 19-year-olds (RR = 7.82; 95% CI: 6.48–9.44). Unintentional injuries were the leading cause of hospitalizations in younger age groups in all urban and rural locations. Rates for unintentional injuries were lower among urban versus rural 5- to 9-year-olds (RR = 0.47; 95% CI: 0.36–0.63) and 10- to 14-year-olds (RR = 0.44; 95% CI: 0.37–0.52).

"Hospitalizations for firearm assaults among urban 15- to 19-year-olds represent the highest injury rate. Notably, hospitalizations are lower for urban versus rural 5- to 9-year-olds and 10- to 14-year-olds, and unintentional firearm injuries are most common among these groups," the authors write. "Preventative public health approaches should address these differences in injury epidemiology."