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Firearms account for the second leading cause of pediatric death in the United States. There is significant variation in firearm legislation at the state level. Recently, three state laws were found to be strongly associated with a reduction in overall deaths from firearms: universal background checks for firearm purchase, ammunition background checks, and identification requirement for purchasing firearms. We performed this study to determine if stricter firearms legislation at the state level and, specifically, the presence of these laws, is associated with decreased pediatric mortality from firearm-related injury.
We performed a cross-sectional analysis of 2015 state-level, firearm-related mortality data of children 0-21 years old from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System. We performed linear regression with log-transformation of non-normal data to measure the association of state gun law scores with firearm-related pediatric mortality rates. The Brady Campaign Gun Law Scores for 2015 were used to generate state-specific scores. Scores ranged from -39 to +76, with higher scores indicating stricter laws. Additionally, the Mann-Whitney U tests were used to determine if there was a difference between median firearm-related pediatric mortality rates and presence of the 3 aforementioned specific state gun laws. Multiple imputation was used to calculate mortality rates for 6 states that were missing mortality data.
4,528 children died from firearm-related injuries in 2015. Mean age was 18 years (SD 3.5), 87% were male, and 44% were of non-Hispanic black race. State-specific mortality rates ranged from 0 to 18 per 100,000 children. Increased pediatric mortality rates were associated with lower state-specific gun law scores (β=-0.3; p-value < 0.001; Figure 1). Median mortality rates were lower among the 12 states requiring universal background checks for firearm purchase (3.8 vs. 5.7 per 100,000 children, p=0.002). Median mortality rates were also lower in the 5 states that required ammunition background checks (2.3 vs. 5.6 per 100,000 children, p=0.02). Only 2 states required firearm identification and no significant difference was found between median mortality rates when comparing these states with those that did not have this requirement (4.6 vs. 5.4 per 100,000 children, p=0.4).
Stricter gun laws, specifically those requiring universal background checks for firearm and ammunition purchase, are associated with lower state-level firearm-related pediatric mortality rates. These findings support the need for further investigation to understand the impact of firearm legislation on pediatric injury.