Firearm-related hospitalizations had dropped before the pandemic, then increased rapidly, study finds

Firearm injuries that sent victims to the hospital had gone down steadily over the five years before the COVID-19 pandemic began, but reversed course sharply over the next two years, a new University of Michigan study finds.

In all, 34% more people were hospitalized for a firearm-related injury in 2020 and 2021 than would have been predicted based on pre-pandemic trends. 

The gap between expected and actual hospitalizations was even bigger for patients under the age of 18, those covered by Medicaid insurance for people with low incomes or disabilities, and those who are Black.  The study is published in JAMA Network Open. 

These groups had firearm hospitalization rates 44%, 46% and 41% higher, respectively, than they would have if pre-pandemic trends had continued.

And while the researchers cannot directly link the rise in firearm hospitalizations to the increase in firearm sales during the first two years of the pandemic, they show a significant association between trends in such sales and trends in firearm-related hospital stays – all the way from the end of 2015 to the end of 2021.

“Taken together, our findings raise new concerns about the sustained increase in firearm-related injury, and in particular the disproportionate increase in younger, low-income and Black individuals,” said Raymond Jean, M.D., M.H.S., the lead author of the new study and a trauma surgeon at Michigan Medicine, U-M’s academic medical center.  

Jean and colleagues used the most recent national hospitalization data available from the federal Healthcare Cost and Utilization Project to create a computer model of the 2015-2019 trends that allowed them to predict expected firearm hospitalizations for 2020 and 2021. 

They then compared those forecasts to what actually happened, revealing the 34% overall increase and the larger increases in some groups. Two major groups had increases smaller than the average: those over age 55 and those insured by Medicare. But even these groups had increases in firearm hospitalization. 

While there are peaks and valleys in firearm hospitalizations and firearm sales every year, both the peaks and valleys for both measures dropped steadily from 2015 to 2019. But by the summer of 2020, firearm hospitalizations had shot up to higher than the highest peak of the previous five years. This lagged the rapid rise in firearm sales during the first months of 2020.

Jean notes that the data source the researchers used does not include data on people who died from a firearm injury before reaching a hospital, or were treated at an emergency department without being admitted to the hospital for at least one night. It also doesn’t include those who didn’t seek care. 

The researchers also can’t tell the exact location where each person was hospitalized, or who fired the firearm that caused the injury. So, they can’t look at the impacts of state-level firearm law changes, COVID-related policies or violence related to social unrest. 

Even so, Jean hopes the findings could help spur further research using other data sources, and inform policy efforts to reduce firearm-related injuries and deaths, including suicides, interpersonal violence and accidents.

“I have seen firsthand what bullets can do to the human body, and worked to save the lives of those who have survived long enough to reach the operating room,” said Jean, who is an assistant professor in the U-M Medical School’s Department of Surgery, in the division of Acute Care Surgery. “That drives my interest in understanding the scope of this issue, and trends over time, through advanced data tools.”

Additional authors: In addition to Jean, the study’s authors are fellow U-M Surgery faculty members Andrew Ibrahim, M.D., M.Sc., Mark Hemmila, M.D., and Staci Aubry, M.D.; statistician Aayushi Sinha, M.S., U-M medical student Sarah Diaz, B.S.N., and Katerina Jou, M.D., a surgical resident at North Shore University Hospital.

Jean, Ibrahim and Hemmila are members of the U-M Institute for Healthcare Policy and Innovation, and the U-M Center for Healthcare Outcomes and Policy.

The study was funded by the Association for Academic Surgery Foundation.

Ibrahim is an editor at JAMA Network Open but was not involved in decisions about the paper’s review or acceptance.

Paper cited: Firearm-Related Injury Hospital Admissions During the COVID-19 Pandemic, JAMA Network Open, doi:10.1001/jamanetworkopen.2024.56234