Researchers Take On 'Great Problem In Data' With Study Of Gunshot Wounds
ROBERT SIEGEL, HOST:
Twenty years ago, under threat from Congress, the Centers for Disease Control and Prevention stopped studying gun violence, so there's been no recent reliable national data on gunshot wounds as a national health problem. Well, that didn't stop Dr. David Livingston and his colleagues. An article in the Journal of Trauma and Acute Care Surgery describes their study of gunshot wound patients in Newark, N.J., more than 6,000 patients over a 12-year period from 2000 through 2011. The study found, among other things, that gunshot wounds have become more lethal and that more patients have had multiple wounds. I asked Dr. Livingston why.
DAVID LIVINGSTON: Well, that's a little unclear, and we really don't understand that. In fact, trauma center care has resulted in a decrease in death and morbidity around the country with all forms of injury except for firearm violence. It's a little hard to understand whether it's higher magazines within a gun. Is it more shooters per event? Is there some other factors we don't know? This is a great problem in data and a lack of data sharing between, for example, health and law enforcement.
SIEGEL: Yesterday, a doctor's group, Doctors for America, coincidentally petitioned Congress to lift the ban on gun research. How would you describe the effect of 20 years of not having solid national data, and what would you gain by having more of it?
LIVINGSTON: Well, if you have data and you have information, you may come up with bad public policy or good public policy, but at least you have data. In the absence of data, you have nothing but conjecture. It would be similar, in a way, if we had no data on the link between obesity and heart disease and diet or smoking and cancer. And imagine we had no data on that for 20 to 30 years. How would you create good health care policy?
SIEGEL: Another finding of this study that was conducted in Newark over 12 years was that trauma registry data - that's information from the hospitals themselves, I thought - seriously underestimates gunshot violence. How is that possible?
LIVINGSTON: Because we see many patients - our emergency department sees many patients with gunshots wounds to the hand, foot - clearly not life-threatening events. They sometimes never come to the attention of the trauma service. So here, I thought we maybe have lost 4, 5, 6 percent. I was completely dumbfounded by the fact that it was 19 percent of the patients that walked through our door that sustained firearm injuries that we never saw on my service.
SIEGEL: You found that there are far more lethal gunshot injuries and more people who've been shot in many parts of their body. Are we simply seeing a different kind of handgun on the streets of Newark at the end of the period you studied than at the beginning?
LIVINGSTON: Quite possibly. I'm not an expert on what is out on the market or what's available. I will say that 98 percent of our patients were injured by handguns.
SIEGEL: A ban on assault rifles wouldn't have much effect on the gunshots in Newark, N.J,, over the course of a year.
LIVINGSTON: Zero - almost zero effect.
SIEGEL: How big a chunk - I know since there's no data, there's no good answer, but how big a problem - a public health care problem is the gunshot wound?
LIVINGSTON: It's a tremendous problem. First of all, many of these patients are poorly or underinsured or noninsured. Often, our trauma centers are our safety-net hospitals in this country. We were very conservative in estimating about $300 million of health care costs, about 75 to 80 percent of it being under or noninsured. So that's just the mere health care costs about it. You know, it tends to happen to young patients, people who have a lot of potential life years to them. The effect on the families indirectly and directly are huge. So I think this is a major public health problem on all aspects of life.
SIEGEL: Dr. Livingston, thanks for talking with us about it today.
LIVINGSTON: Thank you very much for having me.
SIEGEL: That's trauma surgeon David Livingston of the New Jersey Trauma Center at University Hospital in Newark.
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