The Association of State Firearm Legislation With the Burden of Firearm-related Surgery

Elzerie de Jager, Justin McCarty, Molly P. Jarman, Tarsicio Uribe-Leitz, Eric Goralnick, Adil H. Haider, Andrew J. Schoenfeld, Gezzer Ortega

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


Background: United States state-level firearm legislation is linked to rates of firearm-related suicides, pediatric injuries, nonfatal injuries, hospital discharges, and mortality. Our objective was to evaluate the burden of firearm-related injuries requiring surgery for states with strict as opposed to nonstrict firearm legislation. Materials and methods: The 2014 Healthcare Cost and Utilization Project State Inpatient Database was utilized to extract data for all available 28 states and the District of Columbia. States were dichotomized into strict and nonstrict legislative categories using the 2014 Brady and Gifford's scores (15 strict, 14 nonstrict). Patients with a firearm injury requiring surgery were identified and the incidence of surgery aggregated to the county level. Negative binomial regression with an offset for county-level residential population was used to estimate the incident rate ratio for surgical volume comparing counties in strict and nonstrict states. Models were stratified by injury intent and adjusted for county population characteristics. Results: A total of 11,939 patients were hospitalized with firearm-related injuries, with 65% (n = 7759) undergoing an operative procedure. The adjusted incidence rate of firearm-related surgery per 100,000 people was 1.29 (95% confidence interval; 1.13-1.46, P < 0.001) times higher and the adjusted cost of hospitalization per 100,000 people was $6028.69 ($3744.61-$8312.78, P = 0.001) greater for counties in nonstrict states than those for counties in strict states. The burden of health care for these injuries is invariably shifted to state- and county-level finances. Conclusions: The rate of firearm-related surgical intervention was higher for states with nonstrict firearm legislation than that for states with strict legislation. States should reevaluate their firearm legislation to potentially reduce the burden of firearm-related surgery and health care costs.

Original languageEnglish
Pages (from-to)612-618
Number of pages7
JournalJournal of Surgical Research
Publication statusPublished - Nov 2020
Externally publishedYes


  • Firearm legislation
  • Firearm-related surgery
  • Firearms
  • State firearm legislation


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