Kids in disadvantaged zip codes face up to 20 times higher odds of gun injuries, study reveals

Children residing in “very low-opportunity” neighborhoods are up to 20 times more likely to be hospitalized for gun injuries than those living in the most advantaged areas, reports a new multi-state study published in Pediatrics titled “Pediatric Firearm-Related Hospital Encounters by Child Opportunity Index Level.”

The study also found that most hospitalizations for gun injuries among children under 18 are the result of unintentional shootings—incidents caused by mishandling or accidental discharge of a gun.

“The fewer opportunities a child has in their neighborhood, the greater their odds of ending up in the hospital with a firearm injury,” said co-author Dr. Mehul Raval, Head of Pediatric Surgery at Ann & Robert H. Lurie Children’s Hospital of Chicago and Professor of Surgery at Northwestern University Feinberg School of Medicine. He is the Orvar Swenson Founders’ Board Chair in Pediatric Surgery at Lurie Children’s.

This is the first study to examine, across multiple states, how children’s neighborhood conditions are linked to firearm injuries, which is currently the leading cause of death among U.S. children.

“Our study shows that where you and your family live is directly tied to your child’s odds of being injured or killed by a firearm,” said senior author Dr. Anne Stey, Assistant Professor of Surgery at Northwestern University Feinberg School of Medicine and a Northwestern Medicine trauma surgeon. “Unintentional injuries, which are often preventable, make up the largest share of these cases.”

How the study was conducted

Researchers analyzed hospital discharge data for nearly 7,000 gun injuries among children aged 0–17 between 2016 and 2021, capturing every documented case in Florida, Maryland, New York and Wisconsin.

Then they paired those records with Child Opportunity Index (COI) ZIP code data, which ranks neighborhoods from very low- to very high-opportunity based on education, health and socioeconomic factors. This allowed them to identify “hot spots” of firearm injury and see how odds varied by communities.

The findings

More than one in four ZIP codes (28%) in very low–opportunity neighborhoods were hot spots for pediatric firearm injuries, compared with just 5% in very high–opportunity areas.

In Maryland, children in very low–opportunity areas were more than 20 times more likely to be hospitalized with a gun injury than those in the most advantaged neighborhoods. That disparity was nearly 19 times in Wisconsin, 16 in New York, and eight in Florida.

Unintentional shootings were the leading cause of pediatric firearm injuries in all four states, accounting for roughly 57–63% of all hospitalizations, followed by assaults (32–39%) and self-inflicted injuries (1–7%).

Children in high-opportunity neighborhoods were far less likely to be injured, but more than twice as likely to die when they were—in part because self-inflicted injuries were more common in these areas.

Prevention strategies

Because most injuries were unintentional, researchers emphasized implementing prevention strategies at both the policy and community levels in neighborhoods identified as gun violence hot spots. These strategies include safe storage and firearm safety education. They also noted that health systems serving children in low-opportunity areas should anticipate higher volumes of firearm injuries.

“Child Access Prevention laws, which require safe storage of guns, have already been shown to reduce accidental and suicide-related deaths among children,” Dr. Stey said. “Our next step is to measure how these interventions can further lower unintentional firearm injuries.”

The study only included children who presented to an acute care hospital following a firearm injury. Therefore, it misses those who died before reaching a hospital or never sought medical care.