Background: Firearm injuries are a significant cause of morbidity and mortality in young people worldwide. However, firearm injury epidemiology is seldom described outside of the United States. Data from other jurisdictions, where legislation and cultural norms around firearms are different, may provide important data to inform effective firearm injury prevention strategies globally. Furthermore, measuring all firearm injuries, not only deaths, can define the full scope of the problem.
Objective: To examine firearm injuries and deaths among young people in Ontario, Canada, including demographic characteristics, weapon type, and intent.
Design/Methods: Population-based, cross-sectional study using linked health and administrative databases of all children and youth aged 0 to 24 years who presented to an emergency department, were hospitalized or died from a firearm injury in Ontario from April 1, 2003 to March 31, 2017. Multivariable Poisson regression adjusting for age and sex and stratified by injury intent, was used to calculate rate ratios of firearm injuries by weapon type.
Results: Of the 5,486 children and youth injured by a firearm injury (annual rate: 8.7/100,000 population), 90.7% survived. Most injuries and deaths occurred in males (90.1%, 15.3/100,000 population) and in those between 18 and 24 years (61.5%, 17.0/100,000 population). 62.3% (3416) of injuries were unintentional (5.5/100,000 population) of which 1.9% were deaths, whereas 26.5% (1452) were assault related (2.3/100,00 population) of which 18.7% were deaths. Self-harm accounted for 3.7% (204) of cases of which 72.0% were deaths, and legal intervention accounted for 1.1% of cases including 20 (32.7%) deaths. 353 (6.4%) injuries were from an undetermined intent. Non-powdered firearms accounted for almost half (48.6%, 3.9/100,000 population) of firearm injuries. 43.9% of injuries involved vital organs (brain, thorax, abdomen). Over half of the deaths (53.3%) were assault-related while 28.8% were due to suicide. Across all intents, adjusted regression models showed males were at an increased risk of firearm injuries. Compared to handguns, non-powdered firearms had a higher risk of unintentional injuries (adjusted rate ratio [aRR] 14.75 95% CI 12.01, 18.12) and no difference in rates of assault (aRR 0.84 95% CI 0.70, 1.00). Conclusion(s): Firearm injuries are a serious and potentially preventable public health problem among young people in Ontario, Canada. Unintentional injuries and those caused by non-powdered firearms were most common and should be a focus of injury prevention efforts.
Authors/Institutions: Natasha Saunders, The Hospital for Sick Children, Toronto, Ontario, Canada; Charlotte Moore Hepburn, The Hospital for Sick Children, Toronto, Ontario, Canada; Anjie Huang, ICES, Toronto, Ontario, Canada; Claire de Oliveira, ICES, Toronto, Ontario, Canada; Rachel Strauss, ICES, Toronto, Ontario, Canada; Lisa Fiksenbaum, The Hospital for Sick Children, Toronto, Ontario, Canada; Paul Pageau, Ottawa Hospital, Ottawa, Ontario, Canada; Ning Liu, ICES, Toronto, Ontario, Canada; David Gomez, Unity Health Toronto, Toronto, Ontario, Canada; Alison Macpherson, York University, Toronto, Ontario, Canada
