State-Level Estimates of Nonfatal Firearm Injury Hospitalizations, 2000-2021

Objectives

To create a comprehensive, publicly available data set of state-level nonfatal firearm injury inpatient hospitalizations (NFIIHs) in the United States from 2000 to 2021.

Methods

We used Bayesian modeling to impute missing NFIIH rates for 334 state-year observations and correct for incomplete injury mechanism coding in 766 observations.

Results

NFIIH rates increased nationally, with the largest rise between 2019 and 2020, up by one third to reach 1.31 (95% credibility interval [CrI] = 1.27, 1.35) per 10 000 population. State prevalences ranged from 0.18 (95% CrI = 0.14, 0.22) in Hawaii to 2.18 (2.04, 2.33) in Louisiana. South Central states (Mississippi, Arkansas, Missouri) had the largest increases. Twelve states—predominantly in the Northeast and West—experienced decreases. NFIIH rates correlated more strongly with firearm homicide rates (correlation = 0.86) than other intents (correlations < 0.28). Nationwide, there were 2.4 NFIIHs for every firearm homicide, but this ratio varied more than fourfold across states.

Conclusions

NFIIH rates varied substantially across and within states. Despite strong correlation, many states diverged from the national NFIIH to firearm homicide ratio. Public Health Implications: Firearm deaths systematically underrepresent serious firearm injuries in some states. This new data set can inform how policies affect serious firearm injuries and injury lethality.