Study on Gunshot Wounds to the Head Reveals Urgent Public Health Needs and Solutions

Gun violence continues to be a public health epidemic in the U.S., with more than 45,000 deaths per year and 124 daily deaths, according to the Centers for Disease Control and Prevention. In Miami-Dade County alone, the homicide rate has been shown to be 200% higher than the national average, with gunshot wounds to the head (GSWH) being the direst form of violence.

Nathan B. Schoen, M.D./M.P.H. ’19
Nathan B. Schoen, M.D./M.P.H. ’19

To better study this subset, Nathan B. Schoen, M.D./M.P.H. ’19, a current fourth-year general surgery resident at the University of Miami Hospitals and Clinics, conducted a study, “The Cost of Gunshot Wounds to the Head: An Unevenly Distributed Burden,” which was recently published in the journal World Neurosurgery. Dr. Schoen’s goal with the research is to provide an accurate understanding of where and when these injuries occur, to better direct preventive resources.

“We believe this epidemiologic analysis of gun violence will have far-reaching public health implications, especially during this current climate of ongoing violence,” Dr. Schoen said. “Few research studies have examined the prehospital risk factors, social determinants of health, geospatial trends, and its inevitable economic cost.”

Demographic Subsets of Gunshot Victims

Gun violence stats
Geographic association of injury location and
socioeconomic status between Ryder Trauma Center and the Miami Dade County Medical Examiner Department.

The study analyzed data from 402 patients with GSWH who presented alive to the Level I UHealth/Jackson Ryder Trauma Center, and from deceased victims who were transferred directly to the Miami-Dade County Medical Examiner (ME). Researchers found GSWH to have an 89% fatality rate, primarily affecting older white males with an average age of 46, who had committed suicide and were presented directly to the ME. Unlike these ME cases, the Ryder patients were younger Black males with an average age of 31, from low socioeconomic status regions, who had been involved in assaults.

According to the researchers’ geospatial analysis of the hospital patients’ injury ZIP codes, GSWHs significantly cluster in low-income urban areas with higher poverty rates. The analysis further showed that GSWH in the Miami-Dade resulted in approximately $12 million in total health care expenses and $246 million in lifetime productivity losses, according to hospital expenses and socioeconomic census data.

“The growing public health burden of gun violence is evident, and efforts to combat these avoidable injuries necessitate an assessment of the populations at risk,” Dr. Schoen said. “For these efforts to be effective, injury and violence prevention programs must target these hot spots of violence and at-risk populations.”

Violence Prevention Projects

gun violence stats
Differences in patient populations stratified by presenting location.

While gun control remains a hotly debated political topic and the discussion surrounding it is tense, dozens of cities have dedicated resources to focus on mental health and violence prevention initiatives. Organizations such as the National Network for Safe Communities’ Group Violence Intervention have partaken in such measures for over two decades. Results have proven them to be effective, with substantial violence reductions ranging from 40% to 70%.

Miami-Dade County employed a similar program focusing on juveniles in 2019. In addition, the county has used hospital-based violence intervention programs, combining masters-level social workers and medical staff with trusted community-based partners to provide safety planning, services, and trauma-informed care to violently injured people.

“These programs focus on education to mitigate the spread of gun violence by using effective strategies designed to control infectious disease,” Dr. Schoen said. “However, significantly more is needed to bring about meaningful change. By investing in our communities, which possess the unique power to unify and empower citizens from the inside out, we can much more successfully reduce gun violence.”

Tags: DeWitt Daughtry Family Department of Surgery, Dr. Nathan Schoen, gun violence, gunshot, neurosurgery, Ryder Trauma Center, UHealth/Jackson Ryder Trauma Center, World Neurosurgery