Abstract
PURPOSE: Military Veterans and rural residents are at greater risk of firearm injury than non-Veterans and urban residents. This retrospective cohort study used administrative data and electronic health record (EHR) reviews to compare the characteristics of firearm injuries between rural and urban Veterans who presented to the Department of Veterans Affairs (VA) healthcare system. METHODS: A national, stratified random sample of 600 Veterans (300 rural, 300 urban) with firearm injury-related healthcare visits was identified using VA administrative data. Eligible injuries were caused by a firearm and occurred after military separation and between 2010 and 2019. Details about Veterans and firearm injuries were ascertained from administrative data and through EHR reviews. Analyses compared characteristics of firearm injuries by Veterans' rurality. FINDINGS: N = 340 firearm injuries were eligible (178 rural, 162 urban). Most were nonfatal (94.7%). Injury intent differed by rurality, where unintentional injuries comprised a higher proportion of firearm injuries for rural Veterans (55.0% rural, 34.6% urban) and assault-related injuries comprised a higher proportion for urban Veterans (16.3% rural, 37.0% urban). Initial treatment was mostly delivered at facilities outside the VA (82.8%), while follow-up care was mostly at VA facilities (75.8%). Firearm safety counseling was rarely documented (8.3%). CONCLUSIONS: This study describes firearm injuries to inform healthcare-based prevention efforts for rural and urban VA facilities. Differences by rurality in Veterans' injuries suggested that intent-focused tailoring of prevention efforts is critical. Findings highlight opportunities for VA providers to deliver firearm safety counseling. Future research should examine the potential effectiveness of prevention tailored by rurality.