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Both Rural and Urban Children Susceptible to Gun Deaths

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PHILADELPHIA -- Children in the U.S. are just as likely to die from gunshot wounds if they live in the largest cities or the smallest towns. However, teens living in the most urban counties are more likely to die from gun violence, while children in the most remote areas of the country are more likely to die in gun-related accidents or suicides, according to new research by The Children's Hospital of Philadelphia.

Almost 24,000 children and adolescents were killed by guns in the U.S. between 1999 and 2006. The study, which appears in the online issue of the journal Pediatrics, looked at the circumstances of those deaths and found 15,190 were homicides, 7,082 were suicides and 1,377 were classified as unintentional.  The most urban counties experienced disproportionately higher rates of firearm homicide, while the most rural counties experienced higher rates of suicide and unintentional firearm deaths. To reduce these deaths, prevention strategies should be tailored to the needs of these distinct geographic areas.  

"Gun violence doesn't just happen in big cities; it is everyone's problem," said study author Michael L. Nance, M.D., a pediatric surgeon and director of the trauma program at The Children's Hospital of Philadelphia.  "Prevention initiatives should take into account these rural-urban differences."

Children between the ages of 15 and 19 were more than five times more likely to die from intentional gunshot wounds in the most urban counties than in the most rural counties. On the other hand, the suicide and unintentional firearm mortality rates in the most rural counties were nearly four- to five-fold higher than in the urban counties. During the same eight year period, there were more than 113,000 injury deaths that did not involve firearms and they were more likely to occur in rural areas, according to the study.

These findings advance our understanding of firearm-related mortality among children and adolescents in the U.S., the authors said.  While past studies have shown similar disparities in the cause of firearm deaths in the adult population, this is the first study to show it exists in the pediatric population as well.  By collecting mortality information at the county level, the authors were able to analyze a more geographically specific portrait than past studies.

"When one looks at the intent associated with the firearm deaths across the rural-urban continuum however, there is significant variation," Nance said. "Although there is a national need to reduce pediatric firearm injury, specific counties should understand their own distinctive profile of firearm injury and death and tailor their prevention activities according to their specific situation."

Other study authors are Brendan G. Carr, M.D., M.S.; Michael J. Kallan, M.S.; Charles C. Branas, Ph.D. and Douglas J. Wiebe, Ph.D. from The University of Pennsylvania.

"Variation in Pediatric and Adolescent Firearm Mortality Between Rural and Urban America," Pediatrics published online May 24, 2010.

About The Children's Hospital of Philadelphia: The Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking second in National Institutes of Health funding. In addition, its unique family-centered care and public service programs have brought the 460-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit


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