Long-term mortality of patients surviving firearm violence.
OBJECTIVE
We aim to calculate the 5-year mortality after surviving to hospital discharge after a firearm injury and estimate the association of firearm injury with later mortality.


METHODS
We performed a retrospective cohort study of patients from an urban emergency department (ED) and trauma centre in Oakland, California, USA, in 2007. We created three cohorts of patients presenting for (1) gunshot wound (GSW), (2) MVC and (3) assault without a firearm. Demographic and clinical information was obtained from the clinical chart, and the California Department of Public Health Vital Statistics and Social Security Death Master File (2007-2012) were queried to identify patients who died.


RESULTS
We analysed 516 GSW patients, 992 MVC patients and 695 non-GSW assault patients. Of the GSW patients, 86.4% were alive at 5 years. All-cause 5-year mortality among GSW victims surviving to discharge after injury was 5.1%. Compared with MVC patients, both GSW and non-GSW assault patients have higher risk of death at 5 years (HR 2.54 (95% CI 1.41 to 4.59) and HR 1.64 (95% CI 1.01 to 2.68), respectively), adjusting for age, sex and race. Risk of death was higher in the first year for the GSW cohort (HR 6.14 (95% CI 2.35 to 16.08) and HR 5.06 (95% CI 1.88 to 13.63) as compared with MVC and non-GSW assault cohorts, respectively). Homicide was the cause of death in 79.2% of GSW patients who died after surviving the index injury.


CONCLUSIONS
Among individuals presenting to the ED after injury or assault and surviving to discharge, firearm injury exposure is an important predictor of death within 5 years and most pronounced in the first year after injury.
Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, California, USA.
Jahan
J
Fahimi
School of Medicine, University of California, San Francisco, San Francisco, California, USA.
Emily
E
Larimer
School of Medicine, University of California, San Francisco, San Francisco, California, USA.
Walid
W
Hamud-Ahmed
Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, California, USA.
Erik
E
Anderson
Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, California, USA.
C Daniel
CD
Schnorr
Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
Irene
I
Yen
Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, California, USA.
Harrison J
HJ
Alter
D002140:California / Q000453:epidemiology; D019548:Crime Victims / Q000523:psychology / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D005389:Firearms; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014754:Violence / Q000517:prevention & control / Q000706:statistics & numerical data; D014948:Wounds, Gunshot / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control