Association of Community Factors, Firearm Laws, and Pediatric Firearm Injuries

OBJECTIVE: To conduct a zip code-level analysis of community measures and firearm legislation associated with pediatric fatal and nonfatal firearm injuries, ordered by strength of association. METHODS: This was an ecological study of 46 states and the District of Columbia from January 1, 2018 to December 31, 2022. We examined 29 zip code-level variables from the American Community Survey, Social Vulnerability Index, Child Opportunity Index, Giffords Scorecard on Gun Safety Legislation, and the Structural Racism Effect Index. The outcome was the annual incidence of fatal and nonfatal pediatric firearm injuries in each zip code, as included in the National Emergency Medical Services (EMS) Information System (NEMSIS, all 9-1-1 EMS responses) and the Gun Violence Archive (GVA, all police-reported and publicly reported firearm events). We used negative binomial regression and machine learning analysis to evaluate predictors. RESULTS: There were 28 631 zip codes included in the analysis. The average annual incidence of pediatric firearm injuries ranged from 0 to 16 per zip code in NEMSIS, with 1288 (4.5%) zip codes having at least one firearm incident. In GVA, annual incidence ranged from 0 to 35 per zip code, with 1180 (4.1%) zip codes having firearm events. Predictors of firearm injuries included structural racism (in social cohesion, built environment, employment, housing, and criminal justice), urbanicity, household income, unemployment, educational opportunities, and gun laws for background checks and firearm access. CONCLUSIONS: Modifiable community characteristics and certain firearm legislation are associated with pediatric firearm injuries, providing focus areas for community planning, public health, and policy changes to reduce firearm-related injuries and deaths.