Community-Level Disadvantage of Adults With Firearm- vs Motor Vehicle–Related Injuries

Importance Motor vehicle crash (MVC) and firearm injuries are 2 of the top 3 mechanisms of adult injury-related deaths in the US. Objective To understand the differing associations between community-level disadvantage and firearm vs MVC injuries to inform mechanism-specific prevention strategies and appropriate postdischarge resource allocation. Design, Setting, and Participants This multicenter cross-sectional study analyzed prospectively collected data from the American College of Surgeons (ACS) Firearm Study. Included patients were treated either for firearm injury between March 1, 2021, and February 28, 2022, or for MVC-related injuries between January 1 and December 31, 2021, at 1 of 128 participating ACS trauma centers. Exposures Community distress. Main outcome and Measure Odds of presenting with a firearm as compared with MVC injury based on levels of community distress, as measured by the Distressed Communities Index (DCI) and categorized in quintiles. Results A total of 62 981 patients were included (mean SD age, 42.9 17.7 years; 42 388 male 67.3%; 17 737 Black 28.2%, 9052 Hispanic 14.4%, 36 425 White 57.8%) from 104 trauma centers. By type, there were 53 474 patients treated for MVC injuries and 9507 treated for firearm injuries. Patients with firearm injuries were younger (median IQR age, 31.0 24.0-40.0 years vs 41.0 29.0-58.0 years); more likely to be male (7892 of 9507 83.0% vs 34 496 of 53 474 64.5%), identified as Black (5486 of 9507 57.7% vs 12 251 of 53 474 22.9%), and Medicaid insured or uninsured (6819 of 9507 71.7% vs 21 310 of 53 474 39.9%); and had a higher DCI score (median IQR score, 74.0 53.2-94.8 vs 58.0 33.0-83.0) than MVC injured patients. Among admitted patients, the odds of presenting with a firearm injury compared with MVC injury were 1.50 (95% CI, 1.35-1.66) times higher for patients living in the most distressed vs least distressed ZIP codes. After controlling for age, sex, race, ethnicity, and payer type, the DCI components associated with the highest adjusted odds of presenting with a firearm injury were a high housing vacancy rate (OR, 1.11; 95% CI, 1.04-1.19) and high poverty rate (OR, 1.17; 95% CI, 1.10-1.24). Among patients sustaining firearm injuries patients, 4333 (54.3%) received no referrals for postdischarge rehabilitation, home health, or psychosocial services. Conclusions and Relevance In this cross-sectional study of adults with firearm- and motor vehicle–related injuries, we found that patients from highly distressed communities had higher odds of presenting to a trauma center with a firearm injury as opposed to an MVC injury. With two-thirds of firearm injury survivors treated at trauma centers being discharged without psychosocial services, community-level measures of disadvantage may be useful for allocating postdischarge care resources to patients with the greatest need.