Canadian-born children, youth at greater risk of unintentional firearm injury than immigrants

Children and youth born in Canada are at higher risk of unintentional injury from guns compared with immigrant children and youth, although certain subgroups of immigrants and refugees are at higher risk of assault-related injury, found a study published http://www.cmaj.ca/site/press/cmaj.160850.pdf in CMAJ (Canadian Medical Association Journal).

"As pediatricians, part of our role is to ensure the safety and well-being of our patients. Our findings indicate that this is a conversation we should be having with our patients and their families, particularly with these newly identified high-risk populations," says lead author Dr. Natasha Saunders, staff physician in Paediatric Medicine and Associate Scientist at The Hospital for Sick Children (SickKids) in Toronto, Ontario.

In Canada, there is an average of 1300 gun (firearm)-related deaths each year and many more injuries. As the population in Canada changes, it is important to understand what populations are at risk of injury or death. However, there is little evidence on firearm injuries in Canadian children and youth, or on the risk in the immigrant population.

To fill this gap and to identify potential at-risk groups, researchers looked at information on firearm injuries from 2008 to 2012 in 4 million children and youth up to age 24, using health and administrative databases from the Institute for Clinical Evaluative Sciences (ICES). They included Canadian-born children and youth, immigrants and refugees, and looked at patterns associated with rural and urban areas.

Key findings:

• Canadian-born youth, particularly males, have the highest rates of unintentional firearm injury compared with immigrant youth. (Canadian-born males have 12.4 unintentional injuries per 100 000 people versus immigrant males with 7.2 unintentional injuries per 100 000 people).
• Twenty-five percent of firearm injuries are assault-related.
• The risk of being a victim of firearm assault for refugees is 43% higher than for Canadian-born youth.
• Immigrant children and youth from Africa are almost 3 times as likely, and those from Central America are more than 4 times as likely, to be a victim of firearm assault compared with Canadian-born youth.
• Young people living in rural settings are twice as likely to experience unintentional firearm injury compared to those living in cities, who are more likely to be victims of gun violence.

"Most pediatricians in Ontario probably have not seen families who have been impacted by the effects of guns, but I think we would all agree than 1 child or youth injured by a gun is too many," says senior author Dr. Astrid Guttmann, chief science officer at ICES and staff pediatrician and senior associate scientist at SickKids. "The majority of these injuries are unintentional and entirely preventable, making this an important public health problem that needs to be addressed with targeted prevention programs."

The authors note that the immigrant paradox, which theorizes that immigrants have better health outcomes than native-born people, was not seen in the subgroups of children and youth from Africa and Central America.

"Prevention strategies for firearm safety should target nonimmigrant youth as well as these newly identified high-risk immigrant populations," the authors conclude.