The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #72446

Cameron S Crandall, MD¹, Peter Jost, MD¹, David P. Sklar, MD², Lisa Broidy, PhD³, and Gerhard Daday, MA³. (1) Department of Emergency Medicine, University of New Mexico, Center for Injury Prevention Research and Education, ACC 4-W, Albuquerque, NM 87131-5246, 505-272-6521, ccrandall@salud.unm.edu, (2) Department of Emergency Medicine, University of New Mexico School of Medicine, Center for Injury Prevention, Research, and Education, ACC 4 West, Albuquerque, NM 87131-5246, (3) Department of Sociology, University of New Mexico, ACC 4-W, Albuquerque, NM 87131-5246

Objective: To measure emergency department (ED) use among homicide victims, offenders and controls to differentiate risk factors for future violence. Methods: Design: Matched case control. Cases: All police identified county homicide victim (N=361) and offender (N=400) cases 1/96–12/01 who linked to physician billing records. Controls: Randomly selected age (±1 year) and sex matched controls with healthcare use within 3 years of their matched pair’s homicide. Observations: The number and type of ED visits between cases and controls in the 3 years before the homicide. Analysis: Matched pairs odds ratios (OR), 95% confidence intervals (CI). Results: 326 (90%) victims (V) and 337 (84%) offenders (O) linked to healthcare records; of these, 163 (50%) V and 168 (50%) O used healthcare within 3 years prior to the homicide. Cases were male (81%), Hispanic (54%) and were 27.0 years old at homicide. Most cases (64%) and controls (61%) had at least one ED visit 3 years prior to the homicide. Previous firearm injury predicted homicide (OR 15.0, 95% CI 2.0–113.5) and homicide by firearm (OR 9.0, 95% CI 1.1–71.0). Mental health ED visits (OR 2.2, 95% CI 1.1–4.5) and alcohol (OR 2.6, 95% CI 1.1–6.2) predicted non-firearm homicide. ED visits for cases but not controls increased in the months prior to the homicide incident (p<.001). Conclusion: Violence reduction programs may reduce homicide risk for patients with ED visits for non-fatal firearm injuries, mental illness and substance abuse. Intervention should target patients with escalating ED visits.

Learning Objectives:

1. Identify the proportion of homicide victims and offenders and controls who had emergency department visits prior to the homicide.
• Identify risk factors for future homicide victimization and offending. 2. Understand the type and distribution of prior emergency department visits for homicide victims and offenders and controls.

Keywords: Homicide, Prevention

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.