Associations between county-level poverty and firearm injury health encounters in Maryland, USA.

Objective: Firearm injuries are among the four leading causes of injury deaths in the United States. Prior studies have shown the association between poverty and firearm injuries on the national level, but more focused data at the state level has yet to be studied. The objective of this study was to examine the association between county-level poverty and firearm injury health encounters in Maryland, USA. Study design: This was an ecological study conducted on counties in Maryland from July 2015-July 2020. Methods: This study consisted of residents of all ages with firearm injuries who presented to Maryland healthcare facilities. The outcome variables examined were total firearm injury health encounters and injuries by intent (assault, self-harm, and unintentional). The study exposure was county-level poverty concentration divided into tertiles: 0-7.5 %,7.6-12.0 %, and 12.1-25.8 %. Additional covariates included age, race, sex, and urbanicity. Results: Individuals residing in counties in the highest poverty tertile accounted for 16 % of the total population but 52 % of firearm injury health encounters. Counties in the highest poverty tertile had the highest rates of overall firearm injuries, firearm-related assaults, unintentional, and undetermined injuries, compared to counties in the lowest tertile. However, there was no statistically significant difference in the adjusted firearm self-harm incidence rate comparing counties in the highest poverty tertile to the lowest poverty tertile (IRR: 1.9, 95 % CI: 1.0-3.7). Conclusion: Higher levels of poverty are associated with increased rates of firearm injury health encounters in Maryland, underscoring the importance of antipoverty initiatives in addressing firearm injuries.