Racial and Ethnic Disparities in Non-Fatal Self-Inflicted Firearm Injuries Among Adults in the United States, 2000–2021

Nonfatal self-inflicted firearm injuries represent an important and understudied public health concern in the United States. We analyzed nationally representative data from the National Electronic Injury Surveillance System-Firearm Injury Surveillance Study (NEISS-FISS), 2000-2021, to characterize nonfatal self-inflicted firearm injuries among U.S. adults aged 18-64 years. Emergency department (ED) narratives were combined using text mining and an elastic net (LASSO) classification model to augment structured surveillance data. Among 7,362 unweighted cases (representing approximately 260,602 ED visits, 58% were classified as probable unintentional discharges, whereas approximately 10% were probable suicide attempts. Among cases with complete race and ethnicity data, Non-Hispanic White (NHW; 69.2%), Non-Hispanic Black (NHB; 23.2%), and Hispanic (7.6%) individuals comprised the primary analytic groups. Narrative analysis substantially increased detection of contextual factors, particularly alcohol involvement among Hispanic patients (12.0% to 20.1%). NHB patients had the highest proportion of lower-extremity injuries (51%), while Hispanic patients had the highest prevalence of craniofacial injuries (26%). The LASSO model effectively distinguished terms associated with probable suicide attempts from unintentional firearm discharges based on narrative language. Findings highlight limitations of structured intent coding within NEISS-FISS and demonstrate the value of narrative for improving characterization of firearm injury circumstances, revealing distinct racial and ethnic group patterns, to inform more tailored prevention strategies.