The hidden epidemic of firearm injury: Increasing firearm injury rates during 2001-2013

Investigating firearm injury trends over the past decade, we examined temporal trends overall and according to race/ethnicity and intent in fatal and nonfatal firearm injuries (FFIs and NFIs) in United States during 2001-2013. Counts of FFIs and estimated counts of NFIs were obtained from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System. Poisson regression was used to analyze overall and subgroup temporal trends and to estimate annual change per 100,000 persons (change). Total firearm injuries (n = 1,328,109) increased annually by 0.36 (P_trend < 0.0001). FFIs remained constant (change = 0.02; P_trend = 0.22) while NFIs increased (change = 0.35; P_trend < 0.0001). Homicide FFIs declined (change = -0.05; P_trend < 0.0001) while homicide NFIs increased (change = 0.43; P_trend < 0.0001). Suicide FFIs increased (change = 0.07; P_trend < 0.0001) while unintentional FFIs and NFIs declined (changes = -0.01 and -0.09, respectively; P_trend < 0.0001 and 0.005). Among whites, FFIs (change = 0.15; P_trend < 0.0001) and NFIs (change = 0.13; P_trend < 0.0001) increased; among blacks, FFIs declined (change = -0.20; P_trend < 0.0001). Among Hispanics, FFIs declined (change = -0.28; P_trend < 0.0001) while NFIs increased (change = 0.55; P_trend = 0.014). The endemic firearm-related injury rates during the first decade of the 21st century mask a shift from firearm deaths towards a rapid rise in nonfatal injuries.