Injuries/Violence
Racial Disparities in In-Hospital Mortality Following Firearm Injury in a Level I Trauma Center Hiwot Weldemariam* Hiwot Weldemariam Weldemariam Weldemariam University of Washington
Background: Firearm injury is a leading cause of morbidity and mortality in the United States. While racial differences in firearm injury incidence are well documented, little is known about disparities in in-hospital mortality and injury characteristics. Methods: We conducted a retrospective cohort study of patients presenting with firearm-related injuries to a Level I trauma center between January 1, 2004, and December 31, 2024 (n = 6,551), using our institution’s trauma registry. The primary outcome was in-hospital mortality. Race was the primary exposure (Black or African American, White, and Other). We used logistic regression, adjusting for calendar year, injury severity, age, sex, injury intent, and insurance type. Injury severity was classified using the Injury Severity Score (ISS): minor (1–8), moderate (9–15), severe (16–24), and very severe (≥25). Effect modification by injury severity was assessed using race × ISS interaction terms. Results: In adjusted main-effects models, White patients had lower odds of in-hospital mortality compared with Black patients (OR = 0.65; 95% CI: 0.48–0.87). The race × injury severity interaction was statistically significant (p = 0.0025), indicating that racial differences in mortality varied by injury severity. Among patients with severe injuries, Black patients experienced substantially higher odds of mortality compared with White patients (OR = 4.54; 95% CI: 2.06–10.00). There were no statistically significant racial differences in mortality among patients with minor, moderate, or very severe injuries. Conclusions: Racial disparities in in-hospital mortality following firearm injury vary by injury severity. Among patients with severe but potentially survivable injuries, Black patients experience markedly higher mortality compared with White patients, even within the same Level I trauma center. These findings highlight the importance of severity-specific analyses when evaluating racial inequities in trauma outcomes and suggest that disparities in clinical processes or access to timely, high-quality trauma care may be most consequential in the severe injury range.