(441) Pregnancy Under Fire: Disparities in Firearm-Related Injuries During Pregnancy in the United States, 2017-2021

Objective: Firearm violence is a preventable public health crisis in the US, and pregnant patients are not immune from this epidemic. Studies have shown that pregnant individuals are more likely to die due to homicide than the three leading obstetric causes of maternal mortality. Our objective was to evaluate disparities in firearm-related injuries (FRI) during pregnancy.

Study Design:

A cross-sectional analysis of delivery hospitalizations with FRI was conducted using the Nationwide Inpatient Sample from 2017-2021. We analyzed trends of FRI stratified by self-reported race, payor, hospital region, and location/teaching status. Trend significance was determined using the Cochran-Armitage test. Multivariate logistic regression analyses, adjusting for patient and hospital factors, were performed to evaluate the effects of payor, self-reported maternal race, hospital region, and hospital teaching status on the incidence of FRI.

Results:

Of 17.5 million deliveries, 6,365 were complicated by FRI (3.6 per 10,000 delivery hospitalizations). In unadjusted analysis, Black patients (OR 1.35, 95% CI 1.15-1.58) and patients delivering at urban teaching hospitals (OR 1.44, 95% CI 1.1-1.88) experienced higher rates of FRI; this finding did not hold after adjustment for patient and hospital factors. In both univariable and adjusted analyses, patients with public insurance were at increased risk of FRI (Medicare aOR: 3.10, 95% CI 2.07-4.66; Medicaid aOR 1.33, 95% CI 1.12-1.59 vs. private insurance). Rates of FRI were lower in the Midwest (aOR 0.53, 95% CI 0.43-0.65) and South (aOR 0.68, 95% CI 0.58-0.81) compared to the Northeast [Table 1]. Rates of FRI increased over time for non-Hispanic Black, non-Hispanic White, and Hispanic patients, as well as for those with public insurance. Rates of FRI also increased over time at urban teaching hospitals, and in all regions except the Midwest (p< 0.01) [Figure 1].

Conclusion: There are disparities in firearm related injuries by geographic location and payor status in the United States. Knowledge of such disparities can help to guide public policy aimed at preventing gun violence.