P2.P308: Associations between health literacy, child opportunity and pedatric firearm injuries in the United States

Background: Neighborhood-level measures of health literacy and socioeconomic disadvantage affect healthy child development and risk of injury. Health literacy is one’s ability to understand medical information and make decisions for oneself or others. The health literacy index (HLI) is a measure of health literacy at the neighborhood level. The child opportunity index (COI) is a well-validated composite measure of neighborhood-level factors that are important for healthy child development. Pediatric firearm injuries are the leading cause of death in children in the United States, thus representing a significant public health crisis. We sought to evaluate the associations between ecological measures of health literacy and child opportunity -HLI and COI- and the types of firearm injuries that occur in children.

Methods: We performed a retrospective review of all pediatric (≤15 years) firearm injuries using the IBM MarketScan insurance claims database from 2015-2022. Data was merged with the HLI and COI at the zip code level. Patients were grouped into age groups and into COI quintiles (very low, low, moderate, high, and very high). We used frequencies and measures of central tendency (mean and median) to describe our study sample. Multivariate logistic regression was used to assess associations between patient characteristics and types of firearm injury.

Results: There was a total of 1,388 pediatric firearm injuries during the study period; of which 712 had zip code information for which COI and HLI could be determined. Most of the cohort (n=586; 82.3%) was male with a mean age of 12 years (SD=4). Geographically, most firearm injuries occurred in the southern region (n=375; 52.7%), with the remainder occurring in the northeastern (5.76%), north central (23.03%), and western (18.54%) regions of the United States. Most patients in the cohort were from moderate COI neighborhoods (n=480; 67.4%) with the remainder from low and high COI neighborhoods, n=149 (20.9%) and n=83 (11.7%) respectively. There were no injured patients from very low or very high COI neighborhoods. The median HLI was 245 (IQR: 243-250, range: 214-263). Most firearm injuries (n=634; 89.0%) were accidental; 13.3% (n=95) were homicides, and 3.1% were suicides.

On multivariate regression analysis, there were no factors independently associated with firearm injury due to suicide. An increase in COI was associated with reduced odds of homicide (aOR: 0.97 (0.93-0.999). Age between 6-10 years; and living in the Western region were associated with homicide (Table). Factors associated with accidental firearm injury were female sex (aOR: 0.55; 95%CI 0.31-0.97) and age 6-10 (aOR: 6.12;95% CI: 2.18-17.22). Health literacy index was not associated with any type of firearm injury (Table).

Conclusion: Using an administrative insurance database, we found that that an increase in child opportunity index was associated with lower likelihood of homicide. Neighborhood-level health literacy was not associated with firearm injury type.