Firearm Injury Hospitalizations in America

Accurate data on firearm injuries in the United States are critical to understand the full cost or social burden of gun violence.

However, there is no single resource that provides reliable estimates of state-level nonfatal firearm injuries. The data that do exist are sparse, and in some cases, too costly for most researchers to access.

This lack of information limits our ability to answer basic questions about gun violence, such as whether trends in gun injuries are changing over time, or whether existing strategies to reduce firearm-related harms are effective.

As part of the Gun Policy in America initiative, RAND researchers developed a longitudinal database of state-level estimates of inpatient hospitalizations for firearm injury between 2000 and 2016. This database was first released in 2021 and is free to the public.

These estimates draw from several data sources; the largest sources are the summaries of State Inpatient Databases (SID), which are supplemented with other state health department data. The estimates do not include emergency department visits that do not result in a subsequent hospitalization, or gunshot injuries for which hospital-based medical care is not sought.

We estimate that, between 2000 and 2016, there were 547,821 inpatient hospitalizations for firearm injury across the nation.

The data also reveal substantial differences in the rate of inpatient hospitalizations for firearm injury across states, and relatively stable national trends, and could help answer questions about the impact of state policies and the social cost of firearm injuries for states and the nation.

Download full report and data

Average Firearm Injury Hospitalizations, by State

This map represents the number of firearm injuries requiring hospitalization per 100,000 residents, averaged between 2000 and 2016.

  • Alabama 16
  • Alaska 9
  • Arizona 13
  • Arkansas 12
  • California 12
  • Colorado 7
  • Connecticut 7
  • Delaware 12
  • Florida 11
  • Georgia 13
  • Hawaii 2
  • Idaho 5
  • Illinois 13
  • Indiana 10
  • Iowa 4
  • Kansas 10
  • Kentucky 9
  • Louisiana 24
  • Maine 3
  • Maryland 16
  • Massachusetts 5
  • Michigan 14
  • Minnesota 5
  • Mississippi 13
  • Missouri 16
  • Montana 5
  • Nebraska 7
  • Nevada 12
  • New Hampshire 3
  • New Jersey 8
  • New Mexico 8
  • New York 8
  • North Carolina 13
  • North Dakota 4
  • Ohio 10
  • Oklahoma 11
  • Oregon 6
  • Pennsylvania 12
  • Rhode Island 6
  • South Carolina 13
  • South Dakota 5
  • Tennessee 18
  • Texas 10
  • Utah 5
  • Vermont 3
  • Virginia 8
  • West Virginia 10
  • Wisconsin 7
  • Wyoming 5

Average Firearm Injury Hospitalization Rate per 100,000, 2000–2016

  • 0–4
  • 5–9
  • 10–14
  • ≥ 15

This figure displays mean estimated household firearm injury hospitalization rates for states for years 2000 through 2016. Individual state-year estimates, their standard errors, and the data used to produce these estimates are provided in the full dataset.

Annual Change in Firearm Injury Hospitalizations, by State

This chart presents the annual estimated rate of firearm injury hospitalizations between 2000 and 2016.

How it works: Hover over or tap on a line on the chart to identify the state and year shown. To view a specific state, type the name into the field below. As many as four states can be selected at a time.

Estimated rate of firearm injury hospitalizations

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This figure displays estimated annual hospitalizations for firearm injury hospitalizations in each state and the United States overall.

Data and Methodology

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These estimates combined SID data that were available through HCUPnet, and supplemented with data from full state SIDs, web portals that contain state health department data on hospitalization, and data provided by state departments of health in response to direct requests by our study team. This process resulted in 572 state-years with observed firearm hospitalization rates between 2000 and 2016, out of 850 possible. Data on the amount of missing information on the causes of injuries within the state hospitalization data were extracted from two Agency for Healthcare Research and Quality (AHRQ) reports (Barrett et al., 2016; HCUP, undated) that provide the percentage of injuries that are counted in the SID that lack information about the mechanism of injury for specific state-years. The state-years that were still missing data on the number of hospitalizations for firearm injuries were imputed using a range of covariates that were drawn from several sources and were hypothesized to be associated with the rate of firearm hospitalizations. These covariates included the rate of nonsuicide firearm mortality; the rate of reported violent crimes that involved firearms; the proportion of hospitalizations that were reported to be caused by firearms within the National Inpatient Survey (NIS); and a range of state-level annual demographic, economic, and social characteristics.

Both the imputation of missing hospitalization data and the correction for incomplete injury mechanism data were done simultaneously in a single Bayesian regression model. Multiple imputation datasets were created corresponding to the Markov chain Monte Carlo (MCMC) samples from the Bayesian model. The model used a complex error structure that was designed to capture key features of these data, including the larger variance in firearm hospitalization rates for less-populous states-years and the correlation of values within each state over time.

References

  • Barrett, M. C. Steiner, M. Sheng, and M. Bailey, Healthcare Cost and Utilization Project (HCUP) External Cause of Injury Code (E Code) Evaluation Report (Updated with 2013 HCUP Data), Rockville, MD: U.S. Agency for Healthcare Research and Quality, HCUP Methods Series Report # 2016-03, July 26, 2016. As of November 25, 2020: https://www.hcup-us.ahrq.gov/reports/methods/methods.jsp
  • HCUPnet, homepage, undated. As of November 25, 2020: https://hcupnet.ahrq.gov/

Suggested Citation

Rosanna Smart, Samuel Peterson, Terry L. Schell, Rose Kerber, and Andrew R. Morral, "Firearm Injury Hospitalizations in America," RAND Corporation, April 27, 2021. https://www.rand.org/research/gun-policy/firearm-injury.html

Digital Visualization Credits

Heather McCracken (content), Haley Okuley (design), Lee Floyd (development)