Firearm Injury Hospitalizations in America

Accurate data on firearm injuries in the United States are critical to better understand the full cost or social burden of gun violence.

However, there is no single resource that provides reliable estimates of state-level nonfatal firearm injuries. The data that exist are sparse, and in some cases, these data are too costly for most researchers to access.

This lack of information limits researchers' ability to answer basic questions about gun violence, such as whether trends in gun injuries are changing over time or whether existing strategies to reduce firearm-related harms are effective.

As part of the Gun Policy in America initiative, RAND researchers developed a longitudinal database of state-level estimates of inpatient hospitalizations for nonfatal firearm injury between 2000 and 2022.

These estimates draw from several data sources, the largest of which are the summaries of state inpatient databases (SIDs), which are supplemented with other state health department data. The estimates do not include (1) emergency department visits that do not result in a subsequent hospitalization or (2) gunshot injuries for which hospital-based medical care is not sought.

We estimate that between 2000 and 2022, there were 728,617 inpatient hospitalizations for nonfatal firearm injuries across the country: This results in an annual average of about 31,600 nonfatal firearm injuries.

The data also reveal substantial differences in the rate of inpatient hospitalizations for nonfatal firearm injuries across states and relatively stable national trends; these data could help answer questions about the effects of state policies and the social cost of firearm injuries for states and the country.

Download full report and data

Average Rate of Nonfatal Firearm Injury Hospitalizations, by State

This map represents the number of nonfatal firearm injuries resulting in hospitalization per 100,000 residents, by state, averaged between 2000 and 2022.

  • Alabama 15
  • Alaska 11
  • Arizona 12
  • Arkansas 11
  • California 11
  • Colorado 7
  • Connecticut 6
  • Delaware 13
  • Florida 11
  • Georgia 12
  • Hawaii 2
  • Idaho 5
  • Illinois 13
  • Indiana 9
  • Iowa 4
  • Kansas 10
  • Kentucky 9
  • Louisiana 22
  • Maine 3
  • Maryland 15
  • Massachusetts 5
  • Michigan 13
  • Minnesota 5
  • Mississippi 11
  • Missouri 17
  • Montana 6
  • Nebraska 6
  • Nevada 11
  • New Hampshire 2
  • New Jersey 7
  • New Mexico 9
  • New York 8
  • North Carolina 12
  • North Dakota 5
  • Ohio 10
  • Oklahoma 11
  • Oregon 5
  • Pennsylvania 13
  • Rhode Island 6
  • South Carolina 14
  • South Dakota 5
  • Tennessee 17
  • Texas 10
  • Utah 5
  • Vermont 3
  • Virginia 8
  • West Virginia 10
  • Wisconsin 6
  • Wyoming 4

Average Firearm Injury Hospitalization Rate per 100,000, 2000–2022

  • 0–4
  • 5–9
  • 10–14
  • ≥ 15

This figure displays mean estimated nonfatal firearm injury hospitalization rates, by state, for years 2000 through 2022. Individual state-year estimates, their posterior standard deviations, and the data used to produce these estimates are provided in the full dataset.

Annual Change in Nonfatal Firearm Injury Hospitalizations, by State

This chart presents the annual estimated rate of nonfatal firearm injury hospitalizations between 2000 and 2022.

How it works: Hover over or tap on a line on the chart to identify the state and year shown. To view a specific state, type the name into the field below. As many as four states can be selected at one time.

Estimated rate of nonfatal firearm injury hospitalizations

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This figure displays estimated annual hospitalizations for nonfatal firearm injuries in each state and in the United States overall.

Data and Methodology

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Estimates in Smart et al., 2025, include data through 2021. These data have been updated through 2022 for this visualization.

Our model of nonfatal firearm injury hospitalizations combined SID data that were available through the Healthcare Cost and Utilization Project (HCUP), data from full state SIDs, data available through state health department web portals on hospitalization, and data provided by state departments of health in response to direct requests from our study team. This resulted in 808 state-years with observed firearm hospitalization rates between 2000 and 2022 out of 1,150 total state-years. Data on the amount of missing information on the causes of injuries within the state hospitalization data were extracted from two Agency for Healthcare Research and Quality (AHRQ) reports (Barrett et al., 2016; Healthcare Cost and Utilization Project, 2021); these reports provide the percentage of injuries that are counted in the SIDs that lack information about the mechanism of injury for specific state-years. The state-years with missing data on the number of hospitalizations for firearm injuries were imputed using covariates hypothesized to be associated with firearm hospitalizations. These covariates included the rate of nonsuicide firearm mortality; the rate of firearm deaths in medical facilities; the rate of reported violent crimes; and state-level annual demographic, economic, and social characteristics.

Both the imputation of missing hospitalization data and the correction for incomplete injury mechanism data were estimated simultaneously in a Bayesian regression model. This model used a complex error structure that was designed to capture key features of the hospitalization data, including the larger variance in firearm hospitalization rates for less populous state-years and the correlation of values within each state over time. Multiple imputation datasets were created by sampling from the model’s posterior predictive distribution.

References

  • Barrett, M., C. Steiner, M. Sheng, and M. Bailey, Healthcare Cost and Utilization Project (HCUP) External Cause of Injury Code (E-Code) Evaluation Report (Updated with 2013 HCUP Data), U.S. Agency for Healthcare Research and Quality, HCUP Methods Series Report No. 2016-03, July 26, 2016. As of April 13, 2025: https://hcup-us.ahrq.gov/reports/methods/2016-03.pdf
  • Healthcare Cost and Utilization Project, Injuries and External Causes: Reporting of Causes on the HCUP State Inpatient Databases (SID), 2016–2019, updated September 29, 2021. As of April 13, 2025: https://hcup-us.ahrq.gov/reports/ataglance/HCUPanalysisInjuryReporting.pdf
  • Smart, Rosanna, James Murphy, Terry L. Schell, Andrew R. Morral, and Nancy Nicosia, “State-Level Estimates of Nonfatal Firearm Injury Hospitalizations,” American Journal of Public Health, online ahead of print, May 15, 2025.

Suggested Citation

Rosanna Smart, Samuel Peterson, Terry L. Schell, Rose Kerber, and Andrew R. Morral, "Firearm Injury Hospitalizations in America," RAND Corporation, June 11, 2025. https://www.rand.org/research/gun-policy/firearm-injury.html

Digital Visualization Credits

Heather McCracken (content), Haley Okuley (design), and Lee Floyd (development)