Dual pandemic of firearm injury and COVID-19 in Central and Southeastern Ohio: An interrupted time series analysis

BACKGROUND: Firearm injuries increased as the United States faced the onset and first two years of the COVID-19 pandemic, a phenomenon some refer to as the "dual pandemic." Across the country, evidence suggests regional firearm injury rates and related mechanisms behind trends in firearm injury during this time differ, presumably according to local context. This study examines how one regional trauma system fared during the dual pandemic and explores potential explanatory mechanisms of the surge of firearm injuries during the COVID-19 period. METHODS: We used an interrupted time series model to compare quarterly data from 2016-2021 from the COTS (formerly known as the Central Ohio Trauma System) Regional Trauma Registry to examine the proportion of firearm injuries among all trauma cases, case mortality and rates of mistriage among firearm injuries, and the proportion of firearm injuries associated with substance use. RESULTS: Among 3,727 firearm-injured patients, demographic characteristics did not vary with respect to firearm injury, mistriage, mortality, substance use, or alcohol use. Rates of firearm injuries presenting to COTS rose slightly from the beginning of 2020 Q2 (4.54%) through the end of 2020 Q4 (4.71%), and rates continued to grow and remained at a heightened level after the lockdown period. There was no significant change in the growth rate of firearm injuries between 2021 Q2 and 2021 Q3. From 2020 Q4 to 2021 Q2, rates of firearm injury rose 0.99% (CI: 0.05%, 1.9%) from the 2016 average (p