A new study led by Northwestern Medicine has found that children living in “very low-opportunity” neighborhoods face up to 20 times higher odds of being hospitalized for gun injuries compared to those in the most advantaged areas. The research, which analyzed nearly 7,000 pediatric gun injury cases from 2016 to 2021 across Florida, Maryland, New York, and Wisconsin, mapped the risk by ZIP code using Child Opportunity Index (COI) data.
The COI ranks neighborhoods based on education, health, and socioeconomic factors. Researchers paired hospital discharge records with this index to identify areas where children are at greater risk of firearm injuries.
“Our study shows that where you and your family live is directly tied to your child’s odds of being injured or killed by a firearm,” said senior study author Dr. Anne Stey, assistant professor of surgery at Northwestern University Feinberg School of Medicine and a trauma surgeon at Northwestern Medicine. “Unintentional injuries, which are often preventable, make up the largest share of these cases.”
Study co-author Dr. Mehul Raval, professor of surgery at Northwestern University Feinberg School of Medicine and head of pediatric surgery at Ann & Robert H. Lurie Children's Hospital of Chicago added: “The fewer opportunities a child has in their neighborhood, the greater their odds of ending up in the hospital with a firearm injury.”
Findings showed that more than one in four ZIP codes (28%) in very low–opportunity neighborhoods were identified as hot spots for pediatric firearm injuries. In contrast, only 5% of ZIP codes in very high–opportunity areas fell into this category. State-level disparities were significant: In Maryland, children from very low–opportunity areas were over 20 times more likely to be hospitalized for gun injuries than those from the most advantaged communities; similar patterns appeared in Wisconsin (nearly 19 times), New York (16 times), and Florida (eight times).
Unintentional shootings accounted for between 57% and 63% of all pediatric firearm-related hospitalizations across the states studied—more common than assaults or self-inflicted injuries. Children from high-opportunity neighborhoods had lower rates of injury but were more than twice as likely to die when injured by firearms; researchers noted this was partly due to a higher incidence of self-inflicted wounds.
Given these findings, researchers stressed the importance of prevention strategies such as safe storage practices and firearm safety education—especially targeted toward communities identified as gun violence hot spots. Health systems serving low-opportunity neighborhoods should prepare for higher volumes of pediatric firearm injuries.
“Child Access Prevention laws, which require safe storage of guns, have already been shown to reduce accidental and suicide-related deaths among children,” Stey said. “Our next step is to measure how these interventions can further lower unintentional firearm injuries.”
The authors noted that their analysis was limited to children who received care at acute hospitals following a gun injury; it did not include those who died before reaching medical care or never sought treatment.
The study will be published on August 25 in Pediatrics and was funded through donations from families affected by childhood firearm deaths.