Firearm Injury Encounters in the Veterans Health Administration (VHA), 2010-2015

Cynthia Lucero-Obusan, Aaron Wendelboe, Patricia Schirmer, Gina Oda, Mark Holodniy

Abstract


IntroductionFirearm violence is an issue of public health concern leading tomore than 30,000 deaths and 80,000 nonfatal injuries in the UnitedStates annually.1To date, firearm-related studies among Veteranshave focused primarily on suicide and attempted suicide.2-5Herein,we examine firearm violence among VHA enrollees for all manners/intents, including assault, unintentional, self-inflicted, undeterminedand other firearm-related injury encounters in both the inpatient andoutpatient settings.MethodsInpatient and Outpatient encounters with one or more ICD-9-CM firearm external-cause-of-injury codes (E-codes) from1/1/2010-9/30/2015 were extracted from the VHA’s Praedico™Public Health Surveillance System, including demographics, era ofservice/eligibility, encounter type, and deaths. Firearm E-codes wereclassified for manner/intent based on the CDC’s Web-based InjuryStatistics Query and Reporting System (WISQARS™) matrix.6Outpatient/emergency department (ED) data were exclusively fromVHA facilities (a single pediatric patient seen as a humanitarianemergency was excluded from the dataset). Inpatient data includedVHA facilities and some records received from non-VHA facilities.VHA rate of hospitalization for firearm-related admissions wascalculated using the total VHA acute-care admissions for the sametime period as the denominator.ResultsDuring the time frame examined, 5,205 unique individuals wereseen with a firearm E-code. Of these, 4,221 were seen in the outpatient/ED setting only, 597 in the inpatient setting only, and the remaining387 had encounters in both the outpatient/ED and inpatient settings.VHA firearm admission rate was 1.63 per 10,000 VHA admissions,compared to a national rate of 1.96 per 10,000 in 2010.7Table 1 showsthe breakdown of encounters by manner/intent. Unintentional was themost common firearm injury manner/intent. Overall, the median age atinitial encounter was 54 (range 19-100 years), and 96% were male. Thehighest percentage served in the Persian Gulf War Era (2,136, 41%),followed by Vietnam Era (1,816, 35%) and Post-Vietnam Era (716,14%). The greatest number of patients with a firearm-coded encounterresided in Texas (453), California (349), Florida (326), Arizona (214)and Ohio (212).ConclusionsUnintentional injuries were the most common form of firearminjury among VHA enrollees, representing over half of alloutpatient/ED firearm encounters and more than twice the numberof firearm hospitalizations compared with any other manner/intent.Limitations include that not all U.S. Veterans are VHA enrollees;miscoding and misclassification of firearm-related injuries may haveoccurred; and data from non-VHA outpatient/ED encounters andsome non-VHA hospitalizations are not available to our surveillancesystem for analysis. Additional study is needed to further understandthe epidemiology of firearm-related injuries among Veterans andinform VHA leadership and providers

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DOI: https://doi.org/10.5210/ojphi.v9i1.7716



Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org