Survivors of gunshot violence in high-crime urban area at risk of early death

One in 20 survivors of gunshot violence in an urban area with high crime died within five years, mainly by homicide, according to the results of a study that tracked patients after they had been discharged from the hospital that treated them.

In the study published in the journal Injury Prevention, lead author Jahan Fahimi, MD, MPH, of UCSF, and colleagues from UCSF and Highland Hospital in Oakland, Calif., compared mortality rates for three groups of Emergency Department patients.

Approximately 1,000 had been injured in a motor vehicle collision, 700 were victims of non-firearm assaults and 500 had non self-inflicted gunshot wounds. The patients had all been treated in 2007 at Highland Hospital, which serves a high volume of trauma patients requiring life-saving care.

The researchers found that 9 percent of gunshot wound patients died during the initial hospital visit, versus less than 1 percent for those in both the auto accident and non-firearm assault groups. When they looked at the total percentage of people alive five years following discharge, they found that a further 5 percent of the gunshot wound patients had died and that 80 percent of these deaths were attributed to homicide. In contrast 12 percent of the non-firearm injury survivors and 7 percent of the auto accident survivors were victims of homicide in this five-year timeframe.

The study showed that the victims of gunshot wounds were younger, more likely to be male and nonwhite. The average age at hospital admission was 23, 89 percent were male and 94 percent were black or Hispanic; versus age 30 for the auto accident patients of whom 61 percent were male and 65 percent were black or Hispanic.

'After-effects comparable to chronic disease'

"This data supports the theory that violence is not usually an isolated phenomenon," said Fahimi, assistant clinical professor in the Department of Emergency Medicine at the USCF School of Medicine and formerly of Highland Hospital, where the study was initiated.

"The after-effects of surviving firearm injuries, in the population we studied, are comparable to living with a chronic disease, with the risk of death highest during the first year after the injury. Patients victimized by firearms were five to six times more likely to die in the first year, compared to other injured patients. This underlines the importance of in-hospital violence intervention programs, which could alter the life course of these patients."

Fahimi and colleagues plan to replicate their research at multiple sites throughout the country and analyze the significance of factors like substance abuse, mental health and social networks in gun violence.

"This is an area of research that is overlooked and underfunded. Firearm violence receives scant attention compared with other public health issues like smoking and motor vehicle accidents," said Fahimi.

Study excludes 'countless' victims

"Our research suggests that a total of 14 percent of all victims of gunshot violence presented to the Emergency Department are dead within five years, but this is certainly an underestimate of the lethality of firearms used in violent acts, since it does not include the countless victims who died on scene and were never transported to the hospital."

There were 11,208 firearm homicides in the United States in 2013, according to the latest figures from the Centers for Disease Control and Prevention.