Children in Poor Neighborhoods Face Higher Risk of Gun Injuries, Study Finds

Youngsters living in "very low-opportunity" communities are up to 20 times more likely to be hospitalized for firearm injuries than those in the most affluent areas, according to a new multi-state study published in Pediatrics, titled "Pediatric Firearm-Related Hospital Encounters by Child Opportunity Index Level."

The research shows that most hospitalizations for gun injuries among children under 18 are due to unintentional shootings—incidents resulting from mishandling or accidental discharge of a firearm.

"The fewer opportunities a child has in their neighborhood, the higher their risk of being hospitalized with a firearm injury," said co-author Dr. Mehul Raval, Head of Pediatric Surgery at Ann & Robert H. Lurie Children's Hospital of Chicago and Professor at Northwestern University Feinberg School of Medicine.

This study is the first to investigate how children's neighborhood conditions across multiple states are linked to firearm injuries, which are currently the leading cause of death among U.S. children.

"Our findings demonstrate that where a family lives significantly affects a child's likelihood of being injured or killed by a firearm," said senior author Dr. Anne Stey, Assistant Professor at Northwestern University Feinberg School of Medicine and trauma surgeon at Northwestern Medicine. "Preventable unintentional injuries make up the majority of these cases."

Researchers analyzed hospital discharge data for nearly 7,000 gun injuries among children aged 0–17 between 2016 and 2021 in Florida, Maryland, New York, and Wisconsin.

They then correlated this information with Child Opportunity Index (COI) ZIP code data, which ranks neighborhoods from very low- to very high-opportunity based on education, health, and socioeconomic factors. This allowed them to identify "hot spots" for firearm injuries and how risks varied by community.

More than one in four ZIP codes (28%) in very low–opportunity areas were identified as hot spots for pediatric firearm injuries, compared with just 5% in high-opportunity zones.

In Maryland, children in the least advantaged neighborhoods were more than 20 times more likely to be hospitalized with a gun injury than those in the wealthiest areas. This disparity was nearly 19 times in Wisconsin, 16 in New York, and eight in Florida.

Unintentional shootings were the leading cause of pediatric firearm injuries across all four states, accounting for roughly 57–63% of hospitalizations, followed by assaults (32–39%) and self-inflicted injuries (1–7%).

Children in high-opportunity neighborhoods had a lower risk of injury but were over twice as likely to die when injured—in part because self-inflicted injuries were more common in these areas.

Researchers highlighted the importance of implementing prevention strategies at both policy and community levels, especially in areas identified as gun violence hot spots. These strategies include safe storage and firearm safety education. They also emphasized that health systems serving children in low-opportunity neighborhoods should prepare for higher volumes of firearm injuries.

"Child Access Prevention laws, which require safe storage of guns, have already shown reduction in accidental and suicide-related deaths among children," Dr. Stey noted. "Our next step is to measure how these interventions can further lower unintentional firearm injuries."

The study focused only on children who sought treatment at an acute care hospital after a firearm injury. It does not include cases where individuals died before reaching medical facilities or those who did not seek any medical care.