265 - Well-Child Visits Among Youth with Firearm Injuries: A Descriptive Analysis of 2023 Medicaid MarketScan Data

Publication Number: 2255.265

Eileen J. Matos, MUSC, Charleston, SC, United States; Daniel L.. Brinton, MUSC Children's Hospital, Charleston, SC, United States; Daniel Williams, Medical University of South Carolina College of Medicine, Charleston, SC, United States; Kelsey Gastineau, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Elizabeth Oddo, Medical University of South Carolina College of Medicine, Charleston, SC, United States

Background: Firearm injuries among U.S. youth are a growing public health concern, causing immediate harm, long-term disability, trauma, financial strain on families and the healthcare system, and increased risk for future violence. Pediatricians play a vital role in prevention through well-child visits (WCVs), firearm-safety counseling, and mental-health screening. While guidelines support these strategies, no large-scale study has evaluated whether WCVs reduce firearm-injury risk.

Objective: To examine well-child visit (WCV) attendance in the 12 months prior to non-fatal firearm injury among pediatric patients, as an initial step to investigate whether routine primary care engagement may reduce firearm-injury risk.

Design/Methods: We conducted a cross-sectional study using 2023 Meridian MarketScan Medicaid claims. Pediatric patients aged 1-18 years with ≥12 months of continuous enrollment prior to the injury date were included. Firearm injuries were identified using validated ICD-10 codes. Exposure was defined as ≥1 WCV in the prior 12 months (ICD-10 Z00.121, Z00.129). Demographic variables (age, sex, race/ethnicity) and Feudtner complex chronic conditions (CCC) were compared.

Results: We identified 957 firearm-injured pediatric patients, of whom 846 had non-fatal injuries and met inclusion criteria (mean age 15.1 ± 3.5 years; 82% male; 68% Black). Of these, 565 (67%) had no documented WCV in the prior year. Youth without WCV were older (15.7 ± 2.9 vs 14.0 ± 4.2 years), more often male (83% vs 81%), and more frequently identified as Black (71% vs 67%) compared with those with ≥1 WCV (Table 1). Unintentional injuries were the most common intent and were slightly more frequent in those without WCV (73% vs 71%), with no meaningful differences in assault or self-harm injuries (Figure 1). Among injured youth, 16% of the WCV group had a CCC compared with 8.3% of those without WCV. Youth with prior WCVs more frequently had cardiovascular (3.2% vs 1.4%), metabolic (1.1% vs 0.5%), neurologic (1.1% vs 0.7%), and technology-dependent (2.1% vs 1.8%) conditions.

Conclusion(s): In this Medicaid population, most patients with non-fatal firearm injuries had no documented WCV in the prior year, and demographic differences suggested potential disparities in preventive-care engagement. Unintentional injuries were slightly more frequent among youth without prior WCV, highlighting that limited primary-care engagement may represent missed opportunities for firearm-safety counseling. These descriptive findings provide a foundation for future work evaluating whether consistent WCV participation is associated with reduced firearm-injury risk.

Table 1. Demographic Characteristics of Children with Non-Fatal Firearm Injuries by Well-Child Visit Attendance
Children without a documented WCV were older and more frequently identified as Black or Hispanic

Figure 1. Intent of Non-Fatal Firearm Injuries by Well-Child Visit Attendance
Accidental injuries predominated in both groups and were slightly more common among children without a documented WCV.