firearm injuries in children - legislative research commission 18 … · injury 1261 unintentional...
TRANSCRIPT
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Firearm Injuries In Children: A Public Health Crisis
Brit Anderson, MD
Pediatric Emergency Medicine Physician
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Firearm Injuries in Children
Cynthia D. Downard, MD, MMSc
Pediatric Surgeon
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10 Leading Causes of Death, United States2016, All Races, Both Sexes
Age Groups
Rank <1 1-4 5-9 10-14 15-24
1 Congenital Anomalies
Unintentional Injury
Unintentional Injury
Unintentional Injury
Unintentional Injury
2 Short Gestation
Congenital Anomalies
Malignant Neoplasms
Suicide Suicide
3 SIDS Malignant Neoplasms
Congenital Anomalies
Malignant Neoplasms
Homicide
4 MaternalPregnancy
Complications
Homicide Homicide Homicide Malignant Neoplasms
Produced by National Center for Injury Prevention and Control, CDC
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10 Leading Causes of Death, United States2016, All Races, Both Sexes
Age Groups
Rank <1 1-4 5-9 10-14 15-24
1 Congenital Anomalies
4816
Unintentional Injury1261
Unintentional Injury787
Unintentional Injury847
Unintentional Injury13,895
2 Short Gestation
3927
Congenital Anomalies
433
Malignant Neoplasms
449
Suicide
436
Suicide
5723
3 SIDS
1500
Malignant Neoplasms
377
Congenital Anomalies
203
Malignant Neoplasms
431
Homicide
5172
4 MaternalPregnancy
Complications1402
Homicide
339
Homicide
139
Homicide
147
Malignant Neoplasms
1431
Produced by National Center for Injury Prevention and Control, CDC
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10 Leading Causes of Death, United States2016, All Races, Both Sexes
Age Groups
Rank <1 1-4 5-9 10-14 15-24
1 Congenital Anomalies
4816
Unintentional Injury1261
Unintentional Injury787
Unintentional Injury847
Unintentional Injury13,895
2 Short Gestation
3927
Congenital Anomalies
433
Malignant Neoplasms
449
Suicide
436
Suicide
5723
3 SIDS
1500
Malignant Neoplasms
377
Congenital Anomalies
203
Malignant Neoplasms
431
Homicide
5172
4 MaternalPregnancy
Complications1402
Homicide
339
Homicide
139
Homicide
147
Malignant Neoplasms
1431
Produced by National Center for Injury Prevention and Control, CDC
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10 Leading Causes of Death, United States2016, All Races, Both Sexes
Age Groups
Rank <1 1-4 5-9 10-14 15-24
1 Congenital Anomalies
4816
Unintentional Injury1261
Unintentional Injury787
Unintentional Injury847
Unintentional Injury13,895
2 Short Gestation
3927
Congenital Anomalies
433
Malignant Neoplasms
449
Suicide
436
Suicide
5723
3 SIDS
1500
Malignant Neoplasms
377
Congenital Anomalies
203
Malignant Neoplasms
431
Homicide
5172
4 MaternalPregnancy
Complications1402
Homicide
339
Homicide
139
Homicide
147
Malignant Neoplasms
1431
Produced by National Center for Injury Prevention and Control, CDC
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10 Leading Causes of Death, United States2016, All Races, Both Sexes
Age Groups
Rank <1 1-4 5-9 10-14 15-24
1 Congenital Anomalies
4816
Unintentional Injury1261
Unintentional Injury787
Unintentional Injury847
Unintentional Injury13,895
2 Short Gestation
3927
Congenital Anomalies
433
Malignant Neoplasms
449
Suicide
436
Suicide
5723
3 SIDS
1500
Malignant Neoplasms
377
Congenital Anomalies
203
Malignant Neoplasms
431
Homicide
5172
4 MaternalPregnancy
Complications1402
Homicide
339
Homicide
139
Homicide
147
Malignant Neoplasms
1431
Produced by National Center for Injury Prevention and Control, CDC
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Firearm Injuries
• 3rd leading cause of death for children age 1-17 years in the US
• Second leading cause of injury-related death
• 1300 children die and 5800 treated for firearm injuries each year in the US– 53% homicides
– 38% suicides
– 6% unintentional
• Very high case fatality rate
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Firearm Injuries
• 82% of firearm deaths are boys
• African Americans had the highest overall fatality rate– Whites and Native Americans had highest suicide rate
• Young homicide victims are often bystanders
• 4% of children witness a firearm injury each year
• 91% of child firearm deaths in high income countries occur in the US
• 19 children are treated or die in EDs in the US each day from firearm injuries
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0 200 400 600 800 1000 1200 1400
Firearm Deaths
Influenza Deaths
Pediatric Influenza Deaths vs. Pediatric Firearm Deaths in the USA 2016-2017
2017
2016
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What about Kentucky?
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What about Kentucky?
• Public Health Child Fatality Review Program• Established through legislation by the KY
Department for Public Health as a voluntary body• Goal of decreasing child deaths through
prevention efforts• Monitor vital statistics date to identify trends
related to fatalities that may be preventable in Kentucky
• Latest report published November 2017• Summarizes information from 2011-2015
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0
10
20
30
40
50
60
70
80
90
100
2011 2012 2013 2014 2015
Kentucky's Childhood Death Rate by Year of Death, 2011-2015
Dea
ths
pe
r 1
00
,00
0 C
hild
ren
Year
Data Source: Kentucky Vital Statistics, Death Certificate Files 2011-2015, Kentucky State Data Center, Population Estimates 2011-2015
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2011-2015 Kentucky Data
• The majority of deaths among children older than one year of age are due to injury-related causes
• Potential for prevention
• Motor vehicle collision is the most common reason for death
• Increasing number of suicides and at a younger age
• 58% of firearm deaths due to self-harm (suicide)
• Nationally suicide is the third leading cause of death for youth 10-24, but in Kentucky it is the second leading cause of injury related deaths in this age group
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Undetermined 2%
Non-Injury 34%Injury 64%
2015 Deaths among Kentucky Children 1-17 Years of Age by Cause Category
Undetermined (2%; n=4) Non-Injury (34%; n=77) Inury (64%; n=146)
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Deaths among Kentucky Children 1-17 Years of Age by Cause Category for a Typical Year
Motor vehicle collision(21%)
Cancer (11%)
Suicide (7%)
Homicide (6%)Birth Defects (6%)
Drowning (6%)
Other Medical (25%)(Systemic Disease, Infection,
Metabolic Disorders, etc)
Other Injury (14%)(Fire, poisoning, suffocation)
Missing / Undetermined (4%)
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91%
63%
53%
77% 75%
9%
38%
47%
23% 25%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2011 (n=11) 2012 (n=16) 2013 (n=15) 2014 (n=13) 2015 (n=24)
Suicide Deaths among Kentucky Children by Age Group and Year, 2011-2015
10-14 Years
15-17 Years
Year
Perc
enta
ge o
f D
eath
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91%
63%
53%
77% 75%
9%
38%
47%
23% 25%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2011 (n=11) 2012 (n=16) 2013 (n=15) 2014 (n=13) 2015 (n=24)
Suicide Deaths among Kentucky Children by Age Group and Year, 2011-2015
10-14 Years
15-17 Years
Year
Perc
enta
ge o
f D
eath
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45%
69%60% 62%
71%
45%
31%40% 38%
29%
9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2011 (n=11) 2012 (n=16) 2013 (n=15) 2014 (n=13) 2015 (n=24)
Suicide Deaths among Kentucky Children by Mechanism and Year, 2011-2015
Poisoning
Hanging / Strangulation
Firearm
Year
Perc
enta
ge o
f d
eat
hs
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43%
67%
23%
35%
65%
58%
57%
33%
8%5%
4% 2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1-4 years (n=7) 5-9 years (n=6) 10-14 years (n=26) 15-17 years (n=57)
Firearm Deaths among Kentucky Children by Age Group and Manner, Combined 2011-2015
Undetermined Intent
Unintentional
Self Harm
Assault
Age in Years
Perc
enta
ge o
f D
eath
s
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Firearm Injuries and Mental Health
Christopher Peters, MD
Child and Adolescent Psychiatrist
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Jennie Green, MD
Child Abuse Pediatrics Fellow
University of Louisville Pediatric Forensic Medicine
Firearms in Child Abuse and Domestic Violence
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National Violent Death Reporting System • According to the CDC’s National Violent Death
Reporting System, in 2013 approximately 53,000 died of violence-related injuries
• 23.2% of deaths were attributed to homicides
• Deaths involving a firearm or firearms:• 51.4% of suicides • 66.6% of homicides
• Of unintentional firearm deaths, the most common history (28.9%) was playing with a firearm
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Intimate Partner Violence
• In 2010, it was estimated that there were more than74 million people in the US who had experienced IPV (National Intimate Partner and Sexual Violence Survey)
• IPV events that involved a firearm are 12 times as likely to result in death (Saltzman 1992)
• Injuries are more serious when the perpetrator is in possession of a firearm (Kleck 1991; Wells 2002).
• Among men in treatment for IPV who reported owning a firearm, 12% reported a history of using firearms to threaten their partners (Rothman et al 2006)
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IPV and Homicide
• In 2007, 14% of all homicides were committed by intimate partners (Catalano 2009)
• Of all homicides by an intimate partner, 20% of those murdered were “corollary victims” (Smith 2014)
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Corollary Victims
• A corollary victim is a non-intimate partner victim whose death is connected to IPV
• It is estimated 25.4% of victims were 17 years or younger and one third were elementary school age
• 70% of corollary victims were killed by a firearm
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Firearm-Related Child Deaths in Kentucky
Kentucky Vital Statistics, Death Certificate Files 2011-2015.
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Homicide Deaths By Mechanism in Kentucky
Kentucky Vital Statistics, Death Certificate Files 2011-2015.
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Kentucky External Panel and DCBS Statistics• According to the Kentucky Child Fatality and Near
Fatality External Panel Review, there were 567 fatalities and near-fatalities from 2013-2017
• In 2016, there were 3 child fatalities and one child near-fatality where a firearm was involved
• According to DCBS data from 2013-2017 regarding substantiated cases of abuse or neglect, there were 12 child deaths involving a firearm
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A History of Family Violence
• Of all substantiated DCBS cases , 25% of families were found to have a history of violence
• Of fatality and near-fatality DCBS cases, 48% of families were found to have a history of violence
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Conclusions
• Intimate partner violence is very common in Kentucky
• Firearms are frequently used in intimate partner violence
• When firearms are involved in intimate partner violence, children are severely injured or killed as a result
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References• Kleck, G., McElrath, K. (1991). The effects of weaponry on human violence. Social Forces,
69,669-692.
• Wells, W., Horney, J. (2002). Weapon effects and individual intent to do harm: Influences on the escalation of violence. Criminology, 40, 265-296.
• Department of Community Based Services, CHFS. (2017). Child Abuse and Neglect Annual Report of Child Fatalities and Near Fatalities.
• Saltzman, L., Mercy, J., O’Carroll, P., Rosenberg, M., Rhodes, P. Weapon involvement and injury outcomes in family and intimate assaults. JAMA. 1992; 267 (22): 3043-3047.
• Smith, S. G., Fowler, K. A., & Niolon, P. H. (2014). Intimate Partner Homicide and Corollary Victims in 16 States: National Violent Death Reporting System, 2003–2009. American Journal of Public Health, 104(3), 461-466. doi:10.2105/ajph.2013.301582
• Rothman, E., Johnson, R., Hemenway, D. (2006). Gun possession among Massachusetts batterer intervention program enrollees. Evaluation Review, 30, 283-295.
• Kentucky Department for Public Health. (2017). Annual Report: Public Health Child FatalityReview Program.
• Lyons, B. H., Fowler, K. A., Jack, S. P., Betz, C. J., & Blair, J. M. (2016). Surveillance for Violent Deaths — National Violent Death Reporting System, 17 States, 2013. MMWR. Surveillance Summaries, 65(10), 1-42. doi:10.15585/mmwr.ss6510a1
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EMS Perspectives on Firearm Injuries in Children
Morgan Scaggs
KY EMS for Children Project Director