Trends and Disparities in Firearm Injuries Among Emerging Adults: A 15-Year Analysis of Emergency Department Admissions in the U.S.

Introduction: Firearm injuries in the U.S. are rising, with emerging adults (aged 18-24 years) experiencing disproportionately high rates of fatal and nonfatal incidents. This study examines trends, intent-specific patterns, and disparities in fatal and nonfatal firearm injuries among this high-risk age group. Methods: Data were from the Healthcare Cost and Utilization Project's Nationwide Emergency Department Sample (2006-2020), analyzing emergency department admissions for firearm injuries among participants aged 18-24 years. Firearm injuries were classified by intent (assault, unintentional, intentional self-injury, undetermined, other) using International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification diagnosis codes. Trend analyses, descriptive statistics, and logistic regression models were employed to identify patterns and associations by intent and key socioeconomic and geographic indicators. Analysis was conducted in April 2024. Results: Firearm injuries increased annually during Quarter 3 and spiked during the COVID-19 pandemic, particularly for unintentional injuries and assaults. Males had significantly higher odds of firearm injury admissions across all intents than females. Intentional self-injury was more prevalent in rural areas, whereas assault and unintentional injuries were higher in urban areas and among those with Medicaid/Medicare insurance or uninsured. Firearm injury admissions were more likely among individuals from ZIP codes with lower median household incomes, except for intentional self-injury, which showed unique patterns across most indicators. The Northeast had substantially lower firearm-related emergency department admissions across all intents than other U.S. regions. Conclusions: Findings underscore the need for comprehensive strategies to mitigate firearm injuries among emerging adults in the U.S. The significant increase in unintentional firearm injuries and assaults during COVID-19, coupled with the decline in nonfirearm injuries during this time, underscores the complex interplay of social isolation, increased firearm exposure, and broader societal disruptions. Disparities based on sex, insurance status, and geography further emphasize the necessity for public health interventions. Addressing these multifactorial influences and disparities is essential to developing effective, evidence-based policies. Future research should prioritize enhancing data collection on nonfatal firearm injuries and standardizing reporting systems to support these efforts.