Child hospital visits for gun injuries soar 

The number of children visiting U.S. emergency departments for gunshot injuries nearly doubled during the early years of the COVID-19 pandemic, a new study finds.

Researchers looked at data from pediatric emergency departments at nine urban hospitals during the first two-and-a-half years of the pandemic, identifying more than 1,200 firearm injury visits among youth ages 17 and under. In the three years before the pandemic began in March 2020, only about 700 children visited the EDs for gun injuries, according to the study, which was published Nov. 6 in Pediatrics

Survival rates also worsened: Before the pandemic, the number of children injured by firearms who died after reaching the hospital made up 3% of ED visits, increasing to 6% during the pandemic. Researchers suggested that strains on emergency services during the pandemic may have played a role, as well as increases in gun-related suicide attempts, which cause significant physical trauma.

Across the five-plus years of the study, more than half the ED visits involved children ages 15 to 17, and 80% of patients were male. About 64% of the patients were Black, 15% were Hispanic and 11% were white. During the pandemic years, rates of ED visits for firearm injuries rose slightly for Black and Hispanic children and dropped for white children.

Children who visited EDs with gunshot injuries were more likely to be covered by public insurance than private, and about two-thirds of the patients were from low-income communities. 

Firearms became the leading cause of death for U.S. children as of 2020. 

States can set rules to lower locomotive emissions, EPA says

A new rule from the Environmental Protection Agency paves the way for California and other states to better regulate emissions from locomotives that pollute the air of their communities. 

Under the Clean Air Act, states have been prevented from setting emission standards for new locomotives that are more stringent than those issued by the federal government. State lawmakers could regulate emissions from locomotives and their engines that were “non-new,” which were defined as 133% of their useful life, generally equating to about 10 years. The final EPA rule deletes the language defining non-new locomotives, eliminating what public health supporters called a “loophole.”

The change means that California, which is allowed under the Clean Air Act to seek waivers to set stricter vehicle emission standards than federal law, should be able to apply its regulations earlier in the life of a locomotive. Once California takes action, other states are allowed to follow suit.

In April, the California Air Resources Board passed a regulation aimed at reducing nitrogen oxide and diesel particulate matter from locomotives that operate in the state. The California rule requires train operators to pay into a trust account based on how much emissions they create and limits how long the vehicles can idle, among other restrictions. As of 2030, locomotives that are more than 23 years old will not be allowed to be used in the state. 

The California board estimates its measure will prevent 3,200 premature deaths and 1,500 emergency department visits. Cancer risks for people living within a mile of locomotive operations are expected to fall by 90%. 

Connecticut, Delaware, Maine, Maryland, New Jersey, New York, Oregon, Washington, Massachusetts, Pennsylvania, and the District of Columbia joined California in submitting comments to the EPA in support of its new rule.

Black, Hispanic cardiac arrest patients treated at lower-quality hospitals

Black and Hispanic people who experience cardiac arrest are more likely to receive care at lower-performing hospitals, impacting both their long-term health and survival, new research finds. 

Researchers examined data on about 125,000 people across the U.S. who experienced a cardiac arrest and were admitted to a hospital. They found that people from Black and Hispanic communities were more likely to be treated at facilities with lower measures of quality than patients from white communities.

After hospital admission, Black and Hispanic cardiac arrest patients were at higher risk of suffering neurological damage or not surviving, according to the research, which is being presented at the American Heart Association’s Resuscitation Science Symposium.

Patients from Black neighborhoods were treated at top-performing hospitals about 7% of the time, and people from Hispanic neighborhoods were admitted to hospitals 5% of the time, the researchers found. But cardiac arrest patients from white neighborhoods received care at top hospitals almost 31% of the time.

Those rates translated into poorer outcomes for the patients of color, with about 20% people from Black communities likely to survive and be discharged without major neurological damage, compared to 22% of Hispanic people and about 34% of white people.

A related study that zeroed in on cardiac arrest patients in Texas, published in the Journal of the American Heart Association Nov. 6, found similar results. 

More than 356,000 people a year experience cardiac arrests outside a hospital, with most dying before they reach care, according to the American Heart Association. Prior research has shown that people with low incomes and those from communities of color are less likely to receive recommended medical care following cardiac arrest.

U.S. infant death rate climbs for first time in 20 years

The U.S. experienced its highest rate of infant deaths in two decades last year, with Black children disproportionately represented, according to a new report from the Centers for Disease Control and Prevention. 

Provisional data from CDC’s National Center for Health Statistics found the nation’s 2022 infant death rate was 3% higher than in 2021, the first year-to-year increase since 2002. A total of 20,538 infant deaths were reported last year.

Mortality rates were highest among Black babies, at 10.86 deaths per 1,000 live births. But the largest increase in deaths was among infants of American Indian and Alaska Native mothers, rising from 7.46 per 1,000 live births to 9.06. While white infants had the lowest death rate, that rate also increased, from 4.36 per 1,000 live births to 4.52.

Death rates rose for infants of women ages 25 to 29, male infants and infants who were born preterm. Leading causes of death included low birth weight, sudden infant death syndrome, maternal complications and bacterial sepsis.

At the state level, infant death rates increased in Georgia, Iowa, Missouri and Texas and declined in Nevada. The highest rates of infant deaths per live births in 2022 were in South Dakota, Arkansas, Delaware, Louisiana and West Virginia, the report said.

The Watch is written by Michele Late, who has more than two decades of experience as a public-health journalist.