Children in areas with the lowest Child Opportunity Index —which reflects factors like education, social and economic resources — were over twice as likely to suffer another violent injury within a year after an initial firearm-related emergency room visit, according to a study published in JAMA Pediatrics.
In 2020, firearms surpassed motor vehicle collisions as the leading cause of death for children in the U.S. Since then, firearm violence has only continued to worsen, said Samaa Kemal, ’17 MD, ’17 MPH, assistant professor of Pediatrics in the Division of Emergency Medicine, who was first author of the study.
“For this study, we wanted to focus on important outcomes for children who survive a firearm injury, one of which is reinjury from interpersonal violence,” Kemal said. “We hypothesized that if children return to environments with lower opportunity following a firearm injury, they would also be more likely to experience adverse outcomes such as reinjury due to a greater lack of structural resources within their neighborhood.”
In the study, Kemal and her collaborators utilized the Child Opportunity Index (COI), which assesses neighborhoods based on more than 40 factors relating to education, health and environment, and social and economic status.
Investigators analyzed data from more than 6,000 children treated for firearm injuries at one of 49 pediatric hospitals across the country between 2016 and 2023. Of these children, 116 (1.7 percent) experienced another violent injury within one year. The risk was particularly high for adolescents aged 15 to 16, Black children and those living in urban areas.
The study found that 51.7 percent of reinjured children lived in a community with a very low COI score. The findings suggest that neighborhood-level social determinants of health may further perpetuate reinjury for children injured by a firearm, Kemal said.
“This is important because we know that children require a great deal of resources and services after experiencing a firearm injury,” Kemal said. “For children returning to neighborhoods where those key structural resources are difficult to access or simply do not exist, that road to healing and recovery becomes even more challenging, especially as they grapple with other unchanged structural factors that may have contributed to their initial injury.”
Moving forward, Kemal said she and her colleagues will work to understand which factors impact firearm injury the most.
“This more granular information may be particularly interesting to policymakers who are trying to consider specific initiatives or metrics to take action on,” Kemal said. “The biggest takeaway is that now more than ever we must focus on strengthening neighborhoods to decrease the burden of firearm injury and associated outcomes on children, their families, and their communities.”
