Pandemic Jump in ED Visits for Firearm Injuries Continued Into 2022

— Biggest increases among kids under 14, CDC says

A close up photo of tweezers holding a bullet held by a male surgeon.

Emergency department (ED) visits for firearm injuries increased substantially during the COVID-19 pandemic, CDC researchers said.

Compared with 2019, the average number of weekly ED visits for firearm injury was 37% higher in 2020, 36% higher in 2021, and 20% higher in 2022, reported Marissa Zwald, PhD, of the CDC's National Center for Injury Prevention and Control, and colleagues.

There was a "gradual increase" in March 2020, "which coincided with both the declaration of COVID-19 as a national emergency and a pronounced decrease in the total number of ED visits," they wrote in the Morbidity and Mortality Weekly Report.

"Another increase in firearm injury ED visits occurred in late May 2020, concurrent with a period marked by public outcry related to social injustice and structural racism, changes in state-level COVID-19-specific prevention strategies, decreased engagement in COVID-19 mitigation behaviors, and reported increases in some types of crime," they noted.

Among both males and females, average weekly ED visits for firearm injuries were consistently highest among people ages 15 to 24 from 2019 to 2022. However, the biggest increases in the proportion of firearm injury ED visits were among kids younger than 14 during the three pandemic years compared with 2019:

  • Visit ratio (VR) 2.31 for males and 2.81 for females in 2020
  • VR 1.85 and 2.20, respectively, in 2021
  • VR 1.44 and 1.49, respectively, in 2022

"Challenges faced by children and adolescents during the COVID-19 pandemic might have influenced their risk for firearm injury, including disruptions to daily routines and schooling (e.g., social isolation, physical distancing, and increased time spent at home, potentially increasing access to firearms in the home); changes in healthcare access (e.g., limited access to mental health services); and diminished security and safety (e.g., housing and financial insecurity, increased exposure to violence, threat of illness, and uncertainty about the future)," Zwald and colleagues wrote.

"Previous studies have also cited increases in firearm purchases and limited parental supervision as potential factors associated with heightened risk for firearm injuries among children and adolescents during the COVID-19 pandemic," they added.

This report comes as members of the medical community are increasingly making their voices heard on how dangerous and deadly the scourge of gun violence is in the U.S.

Earlier this week, doctors with ties to the Covenant School in Nashville, Tennessee, where three adults and three children were killed in a shooting on Monday, expressed their frustrations and called for more action on gun control.

Zwald and team noted the importance of data when it comes to taking action aimed at addressing the rise of gun violence.

"A comprehensive approach is needed to prevent and respond to firearm injuries and address the social and economic inequities that contribute to the risk for violence," they wrote. "Near real-time ED data can equip public health practitioners, clinicians, researchers, and other partners to quickly identify trends in firearm injuries and develop tailored prevention strategies that fit the needs of their communities."

"Such strategies might include engaging community and street outreach programs that use trusted community members to de-escalate violent conflicts and connect those with the most need to critical support services, implementing hospital-based programs that intervene with victims of violence, improving community physical environments through vacant lot remediation and greening initiatives, enhancing secure firearm storage to reduce access to means among persons at risk for harming themselves or others, and strengthening social and economic supports for persons and families," they concluded.

For this study, Zwald and colleagues used data from the National Syndromic Surveillance Program from January 2019 to December 2022 to examine changes in ED visits for initial firearm injury encounters by year, patient sex, and age group.

They acknowledged a number of limitations to their study, including that the findings may not be generalizable to non-participating facilities, and the limited inference on the underlying prevalence of firearm injuries outside of EDs.

In addition, they pointed out that they assessed changes in counts of ED visits for firearm injuries rather than rates, and said that some demographic data and facility characteristics were unavailable or incomplete at the aggregated national level.

  • author['full_name']

    Jennifer Henderson joined MedPage Today as an enterprise and investigative writer in Jan. 2021. She has covered the healthcare industry in NYC, life sciences and the business of law, among other areas.


Zwald reported no conflicts of interest. A co-author reported unpaid service on the executive planning committee for the National Research Conference on Firearm Injury Prevention.

Primary Source

Morbidity and Mortality Weekly Report

Source Reference: Zwald ML, et al "Emergency department visits for firearm injuries before and during the COVID-19 pandemic -- United States, January 2019-December 2022" MMWR 2023; DOI: 10.15585/mmwr.mm7213a2.