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TOPLINE:

Although emergency department (ED) visits for firearm injuries in Texas remained stable from 2016 to 2022, total charges per visit increased sharply after 2020 and hospital admissions increased by 68%, with higher ED visit rates reported in rural counties and among communities of color.

METHODOLOGY:

• Researchers analyzed 30,664 ED visits for firearm injuries in Texas from 2016 to 2022 using Public Use Data Files obtained from the Texas Health and Human Services Commission.
• They evaluated the association between county firearm ownership levels and firearm injury-related ED visits, adjusting for patient demographics, insurance status, payer type, race and ethnicity, admission status, and county rurality.
• Outcomes were firearm injury-related ED visits and total ED charges for firearm injury-related visits, both further stratified by the type of firearm injury.

TAKEAWAY:

• Each increase in county firearm ownership tercile was associated with a 10.9% increase in firearm injury-related ED visits (P = .05). The most rural counties reported significantly higher annual firearm injury-related ED visit rates than the less rural counties (30.7 vs 20.2 per 100,000 residents; P < .0001).
• Unintentional injury and intentional assault accounted for 82% of all firearm injury-related ED visits. Intentional assault majorly affected adults aged 18-44 years, patients of color, and uninsured individuals (75.7%, 67.1%, and 55.7%, respectively) and was the most common firearm injury type among pediatric patients, accounting for 64.6% of cases.
• Intentional self-harm firearm-related injuries accounted for approximately 10% of cases and were more common among adults aged 45-64 years and White individuals (55.5% and 69.8%, respectively). Compared with other injuries, intentional self-harm and intentional assault yielded higher admission rates (65.1% and 47.6%, respectively) and higher mean ED charges ($124,959 and $80,251, respectively).

IN PRACTICE:

"Texas firearm injuries resulting in ED visits disproportionately impact rural communities and communities of color. Texas counties with greater levels of rurality are more likely to experience higher annual rates of ED visits for firearm injuries. Across payors and county circumstances, the costs associated with ED visits for firearm injury in Texas have increased considerably. This likely reflects a higher proportion of firearm injury ED visits resulting in admission, which may suggest increasing levels of firearm injury severity in Texas," the authors concluded.

SOURCE:

The study was led by Hannah Rochford, PhD, MPH, School of Public Health, Texas A&M University, College Station, Texas. It was published online on May 8, 2026, in The American Journal of Emergency Medicine.

LIMITATIONS:

The study included only firearm injuries resulting in ED visits, potentially underrepresenting individuals with lethal injuries who did not survive long enough to reach the hospital. Race and ethnicity data may contain inaccuracies because they were subjectively recorded. Additionally, the study relied on International Classification of Diseases, 10th Revision E-codes to classify injury intent, possibly overestimating unintentional injuries and underestimating assault-related cases.

DISCLOSURES:

The study did not receive any funding. The authors reported having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.