The Intersection of State Gun Laws and Child Opportunity Index in Pediatric Firearm Incidents

Introduction: Firearm-related injuries are the leading cause of injury-related deaths among children. This study explores the relationships between pediatric firearm injury incidence, Childhood Opportunity Index (COI) as a measure of social determinants of health (SDOH), state gun laws, and surgical specialties involved. Methods: The Pediatric Health Information System (PHIS) was used to identify children diagnosed with firearm injuries and required care from 2015 to 2023. Patient demographics, COI, clinical, and geographic data were examined using univariate analysis, t -tests, and logistic regression. State gun laws were categorized into restrictive, moderate, or permissive based on the Giffords Scorecard and population-adjusted analyses were conducted using U.S. Census Bureau data. Results: One thousand six hundred thirty-six children were included, with a mean age of 11.8 ± 5.0 years. Most injuries occurred in males (79.8%) and White children (64.8%). Mortality was positively associated with low COI scores (OR: 1.010, P = .025). Greater distance from hospitals (OR: 1.01, P = .002) had higher rates of mortality while older age was protective (OR: 0.997, P = .021). Permissive states accounted for 76.4% of injuries, 10.4% in moderate states, 13.2% in restrictive states. Population-adjusted analyses showed higher injury incidences in permissive states versus restrictive states ( P < .01). Pediatric, orthopedic, and plastic surgery were the most involved surgical specialties. Conclusions: Pediatric firearm injuries affect children in neighborhoods with low COI scores, those living farther from hospitals, and in states with permissive gun laws. Plastic surgery was the third most utilized surgical specialty when treating these patients. Further research is needed to inform health policy aimed at mitigating this public health crisis.