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Am J Public Health. 2017 Aug;107(8):1324-1328. doi: 10.2105/AJPH.2017.303837. Epub 2017 Jun 22.

Constant Lethality of Gunshot Injuries From Firearm Assault: United States, 2003-2012.

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Philip J. Cook is with the Sanford School of Public Policy, Duke University, Durham, NC. Ariadne E. Rivera-Aguirre, Magdalena Cerdá, and Garen Wintemute are with the Violence Prevention Research Program, Department of Emergency Medicine, University of California, Davis.



To investigate the validity of the apparent downward trend in the national case-fatality rate for gunshot wounds from assault.


We reanalyzed the estimated annual number of nonfatal firearm injuries the National Electronic Injury Surveillance System reported from 2003 to 2012. We adjusted the estimates for discontinuities created by the substitution of 1 hospital for another in the sample and for a downward trend in the percentage of gunshot injuries classified as "unknown circumstance." Firearm homicide data are from the Centers for Disease Control and Prevention, Web-based Injury Statistics Query and Reporting System.


The unadjusted National Electronic Injury Surveillance System estimate increased by 49%, yielding a decline in the case-fatality rate from 25% to 18%. Our adjustments eliminated these trends; the case-fatality rate was 22% in both 2003 and 2012.


With reasonable adjustments, the trend in nonfatal injuries from interpersonal firearms assault tracks the flat trend in firearms homicides, suggesting that there was no increase in firearms violence during this period. The case-fatality rate did not change, and trauma care improvements did not influence the firearms homicide trend.

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