Gunshot wounds resulting in hospitalization in the United States: 2004-2013.
BACKGROUND
The United States (US) leads all high income countries in gunshot wound (GSW) deaths. However, as a result of two decades of reduced federal support, study of GSW has been largely neglected. In this paper we describe the current state of GSW hospitalizations in the US using population-based data.


METHODS
We conducted an observational study of patients hospitalized for GSW in the National (Nationwide) Inpatient Sample (NIS) 2004 -2013. Our primary outcome is mortality after admission and we model its associations with gender, race, age, intent, severity of injury and weapon type, as well as providing temporal trends in hospital charges.


RESULTS
Each year approximately 30,000 patients are hospitalized for GSW, and 2500 die in hospital. Men are 9 times as likely to be hospitalized for GSW as women, but are less likely to die. Twice as many blacks are hospitalized for GSW as non-Hispanic whites. In-hospital mortality for blacks and non-Hispanic whites was similar when controlled for other factors. Most GSW (63%) are the result of assaults which overwhelmingly involve blacks; accidents are also common (23%) and more commonly involve non-Hispanic whites. Although suicide is much less common (8.3%), it accounts for 32% of all deaths; most of which are older non-Hispanic white males. Handguns are the most common weapon reported, and have the highest mortality rate (8.4%). During the study period, the annual rate of hospitalizations for GSW remained stable at 80 per 100,000 hospital admissions; median inflation-adjusted hospital charges have steadily increased by approximately 20% annually from $30,000 to $56,000 per hospitalization. The adjusted odds for mortality decreased over the study period. Although extensively reported, GSW inflicted by police and terrorists represent few hospitalizations and very few deaths.


CONCLUSIONS
The preponderance GSW hospitalizations resulting from assaults on young black males and suicides among older non-Hispanic white males have continued unabated over the last decade with escalating costs. As with other widespread threats to the public wellbeing, federally funded research is required if effective interventions are to be developed.
Trauma Research Program, Chandler Regional Medical Center, 485 South Dobson Road, Suite 201, Chandler, AZ 85224, USA. Electronic address: adcookmd@gmail.com.
Alan
A
Cook
Department of Surgery, University of Vermont College of Medicine, 789 Orchard Shore Road, Colchester, VT 05446, USA. Electronic address: tosler@uvm.edu.
Turner
T
Osler
Division of Biostatistics and Epidemiology, Department of Public Health School of Public Health and Health Sciences, University of Massachusetts,128 Worcester Road, Stowe, VT 05672, USA. Electronic address: hosmer@schoolph.umass.edu.
David
D
Hosmer
University of Rochester College of Medicine, 601 Elmwood Avenue, Rochester, NY 14642, USA. Electronic address: laurent_glance@urmc.rochester.edu.
Laurent
L
Glance
Trauma and Acute Care Surgery, Lancaster General Hospital, 555 North Duke Street, Lancaster, PA 17602, USA. Electronic address: frogers2@lghealth.org.
Frederick
F
Rogers
Trauma and Acute Care Surgery, Lancaster General Hospital, 555 North Duke Street, Lancaster, PA 17602, USA. Electronic address: bgross2@lghealth.org.
Brian
B
Gross
University of Arizona College of Medicine-Phoenix, 591 East Linda Lane, Gilbert, AZ 85234, USA. Electronic address: pam_ala@yahoo.com.
Pamela
P
Garcia-Filion
Department of Surgery, University of Vermont College of Medicine, 111 Colchester Avenue, Burlington, VT 05401, USA. Electronic address: ajai.malhotra@uvmhealth.org.
Ajai
A
Malhotra
D000059:Accidents / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D006708:Homicide / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012737:Sex Factors; D013405:Suicide / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014754:Violence; D014948:Wounds, Gunshot / Q000191:economics / Q000401:mortality*; D055815:Young Adult
Assault; Firearms; Gunshot wounds; Suicide; Violence