• David Gomez, Natasha Saunders, Brittany Greene, Robin Santiago, Najma Ahmed, and Nancy N Baxter.
• Division of General Surgery (Gomez, Greene, Ahmed), Department of Surgery, University of Toronto; Division of General Surgery (Gomez, Ahmed), St. Michael's Hospital, Unity Health Toronto; Li Ka Shing Knowledge Institute (Gomez, Ahmed, Baxter), St. Michael's Hospital, Unity Health Toronto; ICES (Gomez, Saunders, Santiago, Baxter); Division of Pediatric Medicine (Saunders), The Hospital for Sick Children; Department of Pediatrics (Saunders), University of Toronto; Institute of Health Policy, Management and Evaluation (Saunders, Baxter), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Melbourne School of Population and Global Health (Baxter), University of Melbourne, Melbourne, Australia david.gomez@unityhealth.to.
• CMAJ. 2020 Oct 19; 192 (42): E1253-E1263.

BackgroundFirearm-related injury is an important and preventable cause of death and disability. We describe the burden, baseline characteristics and regional rates of firearm-related injury and death in Ontario.MethodsWe conducted a population-based cross-sectional study using linked data from health administrative data sets held at ICES. We identified residents of Ontario of all ages who were injured or died as a result of a firearm discharge between Apr. 1, 2002, and Dec. 31, 2016. We included injuries classified as assault, unintentional, self-harm or undetermined intent secondary to handguns, rifles, shotguns and larger firearms. The primary outcome was the incidence of nonfatal and fatal injuries resulting in an emergency department visit, hospital admission or death. We also describe regional and temporal rates.ResultsWe identified 6483 firearm-related injuries (annualized injury rate 3.54 per 100 000 population), of which 2723 (42.3%) were fatal. Assault accounted for 40.2% (1494/3715) of nonfatal injuries and 25.5% (694/2723) of deaths. Young men, predominantly in urban neighbourhoods, within the lowest income quintile were overrepresented in this group. Injuries secondary to self-harm accounted for 68.0% (1366/2009) of injuries and occurred predominantly in older men living in rural Ontario across all income quintiles. The case fatality rate of injuries secondary to self-harm was 91.7%. Self-harm accounted for 1842 deaths (67.6%).InterpretationWe found that young urban men were most likely to be injured in firearm-related assaults and that more than two-thirds of self-harm-related injuries occurred in older rural-dwelling men, most of whom died from their injuries. This highlights a need for suicide-prevention strategies in rural areas targeted at men aged 45 or older.© 2020 Joule Inc. or its licensors.

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