Racial/Ethnic Specific Trends in Pediatric Firearm-Related Hospitalizations in the United States, 1998–2011 Bindu Kalesan 1,2,3 • Stefan Dabic 3 • Sowmya Vasan 3 • Steven Stylianos 4 • Sandro Galea 5 Published online: 8 December 2015 Ó Springer Science+Business Media New York 2015 Abstract Objectives To determine the temporal patterns and the difference in trends by race/ethnicity of pediatric firearm hospitalizations (FH) among those aged 15 years or younger in the United States. Methods Data on pediatric FH was retrieved from the Nationwide Inpatient Sample between 1998 and 2011 (n = 16,998,470) using external cause of injury codes (E-codes) of the International Classi- fication of Diseases, Ninth Revision, Clinical modification, (assault: E9650-E9654, unintentional: E9220-E9224, E9228, and E9229, suicide: E9550-E9554, E9556, and E9559, undetermined: E9850-E9854, and E9856 and legal: E970). Meta-regression was used to determine the signifi- cance of temporal trends. Survey logistic regression adjusted for survey year was used to examine association of pediatric FH with social and demographic characteristics. Results An annual reduction of 1.07 per 100,000 hospitalizations (p- trend = 0.011) was observed between 1998 and 2011. There was reduction in rate of unintentional-FH (p-trend = 0.013), suicide-FH (p-trend = 0.029), and undetermined-FH (p- trend = 0.002), but not assault-FH (p-trend = 0.18). A decline in rates of FH was observed among whites (p-trend = 0.021) and Hispanics (p-trend = 0.03) while an increase in rates of assault-FH was observed among black children. All other intents and all other racial/ethnic groups showed declining rates during this interval. Conclusions There was an overall decline in rates of pediatric FHs in this time period driven by a decline in unintentional-FHs. However there was an increase in assault FH among black children during this same time period. Keywords Firearm injury Á Temporal trends Á Injury severity Á Hospitalization Á Pediatric Abbreviations FH Firearm hospitalization Significance Firearm-related morbidity and mortality among children is markedly high in the United States. Pediatric fatal and non-fatal firearm injuries have demonstrated a decline, but differences in temporal patterns according to racial/ ethnic groups or intent of injury have not yet been documented. We found a reduction in overall pediatric firearm hospitalizations (FH) over 14 years, which was driven by a decline in unintentional injuries. FHs were more likely to be black than white children, with a decline among white and Hispanic children and a sig- nificant increase among black children hospitalized due to assault firearm injuries. & Bindu Kalesan kalesan@bu.edu 1 Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Ave, Suite 470, Boston, MA 02118, USA 2 Gun Violence Survivors Foundation, Philadelphia, PA, USA 3 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA 4 Department of Surgery, Columbia University Medical Center, New York, NY 10032, USA 5 Boston University School of Public Health, Boston, MA 02118, USA 123 Matern Child Health J (2016) 20:1082–1090 DOI 10.1007/s10995-015-1894-8