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New Study Shows Economic Toll and Geospatial Trends of Gunshot Wounds to the Head in Miami-Dade County

Nathan Schoen, a graduate of the M.D./M.P.H. program from the Department of Public Health Sciences at the University of Miami Miller School of Medicine, is the primary author of a new research study ­– an in-depth epidemiologic study on gun violence in Miami.

The study, titled “The Cost of Gunshot Wounds to the Head: An Unevenly Distributed Burden” was recently published in World Neurosurgery in January 2023.

Nathan B. Schoen, M.D., M.P.H., teamed up with colleagues in the Neurosurgery and Medical Examiner (ME) departments starting in 2015 to study the direst subset of gun violence – gunshot wounds to the head (GSWH) in Miami-Dade County (MDC). “We believed it would have far-reaching public health implications, especially during this current climate of ongoing violence,” said Dr. Schoen, who is now a 4th year General Surgery resident at the University of Miami Hospitals and Clinics, and a Lieutenant in the U.S. Navy Medical Corps.

Nathan Schoen, M.D., M.P.H.

According to the authors, “Gun violence has reached epidemic levels in the United States, accounting for 17.3% of all injury deaths. The homicide rate in MDC has been shown to be 200% higher than the national average. GSWH portend a particularly poor prognosis and makeup around 50% of injuries from firearms.”

“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,” added Dr. Schoen. “However, there aren't many research studies that have examined the prehospital risk factors, social determinants of health, geospatial trends, and its inevitable economic cost. We aimed to provide an accurate understanding of where and when these injuries occur to better direct preventive resources.”

To accomplish this, Dr. Schoen along with other researchers created a retrospective study with primary data collection spanning over ten years from 2008 to 2017. To quantify the full picture of GSWH, they sought out both patients who presented alive to the level one Ryder Trauma Center (hospital) as well as deceased victims who were transferred directly to the ME department. They are among the first studies to include this often-unrepresented population of patients whose injuries were fatal at the scene, as well as those who experience polytrauma with multiple gunshot wounds (GSWs).

In addition, only patients with penetrating brain injuries were included. A total of 402 consecutive patients met the inclusion criteria, with 297 (74%) presenting to the ME and 105 (26%) to the hospital.

“The economic toll in our cohort of GSWH in MDC alone was calculated to be approximately $12 million in total health care expenses and $246 million in lifetime productivity losses,” exclaimed Dr. Schoen. The researchers found GSWH to have an 89% fatality rate, primarily affecting older, white males who committed suicide and presented directly to the ME. Unlike these ME cases, the hospital patients were more likely to be black males from low socioeconomic status regions involved in assault.

According to the researchers' geospatial analysis of the hospital patients’ injury zip codes, GSWH are significantly clustered in low-income urban areas with higher poverty rates.

Number of Ryder and ME patients.

“Injury and violence prevention programs must target these hot spots of violence and at-risk populations to reap the maximal effects,” said Dr. Schoen. “Our findings directly support the utility of public health interventions, which if successful, could alleviate the substantial economic burden both in MDC and the rest of the U.S.”

For more than two decades, dozens of cities have used the National Network for Safe Communities' Group Violence Intervention, resulting in 40%-70% reductions in violence.

“These programs use effective infectious disease control strategies to educate people in order to reduce the spread of gun violence. We can significantly reduce gun violence by investing in our communities, which have the unique ability to unite and empower citizens from the inside out," concluded Dr. Schoen.

Written by Deycha Torres Hernández
Published on February 21, 2023