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Long-term mortality of patients surviving firearm violence
  1. Jahan Fahimi1,2,
  2. Emily Larimer3,
  3. Walid Hamud-Ahmed3,
  4. Erik Anderson2,
  5. C Daniel Schnorr2,
  6. Irene Yen4,
  7. Harrison J Alter2
  1. 1Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
  2. 2Department of Emergency Medicine, Highland Hospital—Alameda Health System, Oakland, California, USA
  3. 3School of Medicine, University of California, San Francisco, San Francisco, California, USA
  4. 4Department of Medicine, University of California, San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Jahan Fahimi, Department of Emergency Medicine, University of California, San Francisco, 505 Parnassus Avenue, L126, San Francisco, CA 94143-0209, USA; jahan.fahimi{at}ucsf.edu

Abstract

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.

Conclusion 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.

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