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Half as Many U.S. Children Die from Firearm Injuries Where Gun Laws are Strictest


AAP contacts: Laura Alessio, 630-626-6276 or
                       Lisa Black, 630-626-6084 or

 Research abstract to be presented at American Academy of Pediatrics 2018 National Conference & Exhibition finds strong correlation even after adjusting for factors such as poverty, unemployment and education rates.

ORLANDO, Fla. – New research shows dramatic differences in the number of children hospitalized and killed each year in the U.S. from firearm-related injuries based on their states' gun legislation, even after adjusting for poverty, unemployment, and education rates. It found twice as many pediatric firearm deaths in states with the most lenient gun regulations compared with states where gun laws are strictest.

Researchers will present an abstract of their study, "Strict Firearm Legislation Is Associated with Lower Firearm-Related Fatalities among Children and Teens in the United States," at the American Academy of Pediatrics 2018 National Conference & Exhibition. Study authors examined pediatric injury-related deaths and mortality rates derived from the National Vital Statistics System maintained by the Centers for Disease Control's National Center for Health Statistics and then compared regional injury with the Brady Campaign scorecard, which rates gun law stringency by state.

Beyond lower pediatric firearm-related mortality within individual states, the study researchers found that stringency of a neighboring state's firearm legislation was also associated with pediatric firearm mortality rates. The researchers also found that firearm laws specific to child access prevention (CAP), including locking mechanisms or storage requirements, were associated with decreased firearm suicide rates among children. States without CAP laws had pediatric firearm suicide rates more than four times as high as those with CAP laws.

"Firearm-related injuries are the second leading cause of death among children in the United States, but we found a clear discrepancy in where those deaths happen that corresponds with the strength of states' firearm legislation," said Stephanie Chao, MD, FAAP, FACS the abstract's lead author. "In states with lenient laws, children die at alarmingly greater rates."

The same researchers will also be presenting findings from a related study they performed, "U.S. Regional Trends in Pediatric Firearm-Related Injuries." In this study, analysis showed regions with high average Brady scores (Northeast and West) were associated with 7.54 injuries per 100,000 children, while rates in low Brady scores regions (Midwest and South) had 8.30 injuries per 100,000 children.

"Each year, more children die from firearm-related injuries than from cancer and heart disease combined," said Dr. Chao, Trauma Medical Director and Assistant Professor of Pediatric Surgery at Stanford School of Medicine. "However, each and every one of these deaths is preventable. Our study demonstrates that state-level legislation prevents children from dying from guns."

Dr. Chao and co-author Jordan Taylor, MD, Postdoctoral Research Fellow in Pediatric Surgery at Stanford, said a better understanding of regional differences in pediatric patterns of firearm-related injuries, compared with existing firearm legislation, can better inform each region's targeted prevention efforts.

"While federal legislation on firearms remains a contentious and gridlocked issue," Dr. Chao said, "we found that state legislation may be an opportunity to prevent pediatric deaths from firearms."

Dr. Taylor will present the study abstract on firearms legislation at 3:30 pm ET on Monday, Nov. 5, and the study abstract on regional trends in pediatric firearm injuries at 5 p.m. ET on Monday, Nov. 5, both in the Plaza International Ballroom at the Orange County Convention Center in Orlando, Fla. Abstracts included below.

In addition, Dr. Taylor will be among highlighted abstract authors available during an informal Media Meet-and-Greet session Saturday, November 3, from 1 pm. To 1:45 p.m. ET in room W208AB of the Orange County Convention Center (Press Office).  During the meeting, you may reach AAP media relations staff in the National Conference Press Room at 407-685-5404.


Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal. 


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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at


Abstract Title: Strict firearm legislation is associated with lower firearm-related fatalities among children and teens in the United States

Jordan Taylor, MD; Sriram Madhavan, MS; Stephanie Chao, MD
Stanford, CA

Introduction: Firearm-related injuries are the second leading cause of pediatric death in the US. We sought to evaluate the effectiveness of state child-access prevention (CAP) laws and gun regulations on pediatric firearm mortality (PFM). We hypothesized that states with more stringent firearm legislation had lower PFM.

Methods: We used 2014-2015 PFM data from the Web-Based Injury Statistics Query and Reporting System, 2014 Brady scores (used to quantify stringency of state gun regulations), and 2014 CAP laws (indexed by the Law Center to Prevent Gun Violence). Spearman rank correlations and linear regression were used to determine the relationship between PFM and gun regulations.

Results: Annually, there were approximately 2,715 pediatric firearm fatalities; 62.1% were homicides and 31.4% were suicides. There was a significant negative correlation between states' firearm legislation stringency and PFM (ρ = -0.66), and between presence of CAP laws and firearm suicide rates (ρ = -0.56). There was a positive correlation between unemployment rate and firearm homicide rate (ρ = 0.55), and between teen tobacco use and firearm suicide rate (ρ = 0.50). After controlling for poverty, unemployment, and substance abuse, the association between firearm legislation stringency and PFM remained significant (p < 0.01). There was an association between CAP laws and firearm suicide rate after controlling for socioeconomic factors and other firearm legislation (p < 0.01). 

Conclusion: Strict gun legislation was associated with fewer pediatric firearm fatalities. CAP laws were associated with fewer firearm suicides. State-level legislation could play an important role in reducing pediatric firearm-related deaths.


Abstract Title: US Regional trends in pediatric firearm-related injuries

Jordan Taylor, MD; Sriram Madhavan, MS; Lakshika Tennakoon; Kristan Staudenmayer, MD; Stephanie Chao, MD
Stanford, CA

Introduction: Firearm-related injury (FRI) is a major cause of preventable death and disability among children in the United States. However, little is known about regional patterns in pediatric FRI and regional firearms legislation. We hypothesized that regions with more stringent firearm legislation would have a lower incidence of pediatric FRI.

Methods: The study examined inpatient admissions for pediatric patients in 2012 using the Kids´ Inpatient Database (KID), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality; US Census Bureau; and the 2013 Brady scorecard, which assesses gun law stringency by state. The average Brady scores were computed for each US region and compared to FRI incidence rates.

Results: In 2012, 6,941 children (0-20 years) were hospitalized for FRI. Among pediatric FRI, 36% occurred in the South, 22% in the West, 25% in the Midwest, and 17% in the Northeast. Overall, 6.9% resulted in fatalities. Boys, older children, children in low-income zip codes, and black and Hispanic children were disproportionately affected. More stringent regions with high average Brady scores (Northeast and West) were associated with 7.54 injuries per 100,000 children, while rates in low Brady scores regions (Midwest and South) were 8.30 injuries per 100,000 children (difference in FRI of 0.76 per 100,000 children, 95%CI:0.38-1.13, p<0.001).

Conclusion: At a high level, rates of injuries are associated with stringency of gun laws. A better understanding of regional variations in pediatric patterns of FRI and existing firearm legislation can better inform each region's targeted prevention efforts.