THE DISTRESS COMMUNITY INDEX: A MEASURE OF COMMUNITY-LEVEL ECONOMIC DEPRIVATION AND FIREARM INJURIES RATES IN MARYLAND

Objectives: Although previously published studies have shown the role of social and economic factors in incidences of firearm injuries, no universal measure of socioeconomic deprivation captures the problem's complexity. Measures of community-level economic deprivation, such as the distressed community index (DCI), provide a different perspective on the association between firearm injuries and social determinants of health. In the present study, we determined the association between DCI (a measure of community-level economic deprivation) and rates of firearm injuries in Maryland.

Methods: Utilizing the Maryland State Inpatient Database (SID), we conducted a retrospective analysis of all Emergency Department (ED) visits because of firearm injuries (Assaults and Unintentional) from January 2019 to December 2020. We determined the association between community-level economic deprivation using the Distress Community Index (DCI) and incidences of firearm injuries. The DCI utilizes seven variables, based on zip codes, generating five levels of socioeconomic distress (prosperous, comfortable, mid-tier, at-risk, and distressed). In the final multivariate analysis, we adjusted for patients' age, sex, and mental conditions such as depression, bipolar disorders, anxiety disorders, impulse disorders, and dementia. We also accounted for alcohol addiction, substance abuse, smoking, patients' race/ethnicity, insurance type, and median income.

Results: There were 2767 ED visits because of firearm injuries in the Maryland SID in the study period. Most of these patients were Blacks, 84.5%, and males (88.5%). The median age was 27(21-35) years. The mortality rate was 17.7%. There is a statistically significant association between community-level economic deprivation and the incidence of ED visits because of firearm injuries (assaults and unintentional). Prosperous, reference, Comfortable, OR=1.23, 95% CI 1.01-1.49, p=0.04), Mid-tier, OR=1.56, 95% CI 1.25-1.93, p < 0.001, At-Risk, OR= 1.32, 95% CI 1.02-1.72, p=0.04), Distressed, OR=2.05, 95% CI 1.51-2.77, p< 0.001).

Conclusion: The distress community index adequately captures the association between community-level economic deprivation and incidences of firearm injuries in Maryland.