Background: Racial disparities in firearm injury death in the United States are well established. Less is known about the magnitude of nonfatal and total firearm injury.
Objective: To combine health care data with death certificate data to estimate total firearm injuries in various racial and ethnic groups.
Design: Retrospective, cross-sectional study.
Setting: Fatal injury data were collected from the Centers for Disease Control and Prevention. Data on nonfatal injuries were collected from the Nationwide Emergency Department Sample (NEDS), a 20% stratified sample of U.S. emergency department visits, weighted to provide national estimates for the United States, 2019 to 2020.
Participants: All firearm injuries and deaths in the United States.
Intervention: Race and ethnicity were classified into 5 mutually exclusive categories: Asian or Pacific Islander, Black, Hispanic, Native American, and White. International Classification of Diseases, 10th Revision codes were used to classify firearm injury intent.
Measurements: Incidence of fatal and nonfatal injury in the U.S. population and case-fatality ratios (CFRs).
Results: There were 252 376 total firearm injuries, including 84 908 deaths from firearm injures. Of all firearm injuries, 37.8% were unintentional, 37.3% were assault related, 21.0% were self-harm, and 1.3% were law enforcement associated. Self-harm had the highest CFRs (90.9% overall). Unintentional injuries accounted for just 1021 (1.2%) deaths but 94 433 (56.4%) of nonfatal injuries. Rates of self-harm were highest among White persons (11.0 per 100 000 population in 2020) followed by Native Americans (8.6 per 100 000). Rates of assault were highest among Black persons (70.1 per 100 000), as were unintentional injuries (56.1 per 100 000).
Limitation: Findings are limited by the accuracy of discharge coding in NEDS, particularly regarding injury intent and patient race and ethnicity.
Conclusion: From 2019 to 2020, the total burden of firearm injuries amounts to an average of 1 injury every 4 minutes and 1 death every 12 minutes in the United States. Racial disparities in firearm injury death are mirrored in nonfatal injury.
Primary funding source: None.