Gun deaths have been increasing in Oregon for years and new research is now making the full toll of gun violence more clear in the state.
Nonfatal gun injuries treated by emergency departments statewide have increased more dramatically than gun deaths in recent years, a report released in December by researchers at Oregon Health & Sciences University’s Gun Violence Prevention Research Center shows.
Between 2019 and 2021, ER visits for nonfatal gun injuries nearly doubled from 459 to 873 in the state, according to the report. That’s compared to an 18% increase in gun deaths between those years, according to official and preliminary mortality data from the U.S. Centers of Disease Control and Prevention.
The report marks the first time data on gun-related injuries that people survived has been compiled in Oregon. It was also the inaugural report by the research center, which launched earlier this year in partnership with the Portland State University School of Public Health.
The center aims to treat gun violence as a public health issue. Similar to how society would address the outbreak of infectious disease, researchers will use data-driven science to inform prevention strategies and reduce health impacts.
Gun deaths from a public health perspective
The approach was effectively blocked by a law that, until recently, forbade federal funding for gun violence research for more than 20 years, injury epidemiologist and the report’s lead author Kathleen Carlson said.
In 1996, Congress passed a spending bill with a provision that stopped CDC funds for injury prevention from being used to “advocate or promote gun control.” While the Dickey Amendment, which was lobbied for by the National Rifle Association and named after former Arkansas Rep. Jay Dickey, didn’t explicitly ban gun research, the CDC avoided research on gun violence for fear it would be penalized.
As a result, public health researchers were careful not to talk about guns because they thought they’d lose funding for their work.
In 2018, Congress clarified the provision to allow for such research and the first funding for it came in the 2020 spending bill.
The OHSU-PSU research center has been fueled by that change, partnering with the Oregon Health Authority (OHA) to monitor gun injuries using CDC funds and seed money from the Silver Family Innovation Fund.
New insight to gun injuries
Improving data on nonfatal gun injuries is a crucial piece to understanding the overall impact of gun violence on communities and creating programs to address it, Carlson said.
“We’ve had pretty robust data on (gun-related) causes of death for a number of years,” she added. “What we haven’t had is a way to hone in on nonfatal firearm injuries. If we can get a handle on those numbers in combination with the fatal injuries, those can work together to flatten the curve.”
To produce the report, researchers analyzed injury reports submitted by emergency departments to a state public health surveillance system that was originally created to detect bioterrorism in the aftermath of the 9/11 attacks. The OHA was one of 10 state health agencies to receive federal funding for three years to use that method. It will allow researchers to access near real-time gun injury reports and update a new dashboard with the data on a quarterly basis.
Much of the state’s increase in gun injuries can be attributed to the Portland area, where nonfatal injury shootings increased by 240% between 2019 and 2021, according to data from the Portland Police Bureau. But the OHSU report reveals that gun injuries are not exclusive to Portland, Carlson said.
While Multnomah County had among the highest rates of gun injuries per capita, two rural counties — Douglas and Jefferson — had similarly high rates of more than 80 per 100,000 residents between 2018 and 2021, according to the report.
Carlson speculated that the high rates of gun injuries in more rural areas could be related to a combination of guns being a part of everyday life and a need for better gun safety training.
She added that researchers are also focused on analyzing the intent behind incidents that result in gun injuries.
“That’s really going to help our prevention efforts,” Carlson said.
The researchers manually reviewed more than 2,100 entries in the surveillance system to classify them by intent. Nearly 20% of the 1,753 ER visits researchers classified as gun injuries were unintentional, or not caused by assault or intentional self-harm, based on the researchers’ review.
That’s roughly the same proportion of injuries found to be intentional. Gun injuries caused by assaults made up 15%, and those inflicted due to self-harm accounted for 5%, according to the report.
There’s a lot of room for improvement in terms of classifying gun injuries by intent, Carlson said. Researchers could not determine intent for 60% of the gun injuries they analyzed. That’s partly because it’s complicated to collect reliable information in an emergency department; patients are often unable or uninterested in providing the information.
“It may be that they’re too swamped in emergency departments to spend much time coding records,” Carlson said, adding that she and her colleagues are looking for ways to help emergency departments perform the task.
The report also provides detail on the impact of gun violence on people of color.
The report found that 14% of people who visited an ER for a gun injury in Oregon between 2018 and 2021 were Black, despite the group making up 2% of the state’s population. Additionally, 12% of the visits were among Latino/Hispanic people, while the group accounts for 9% of the population.
People injured were also overwhelmingly men, with ER visits for gun injuries by males seven times higher than that for females, the report shows. The most affected age group was people 25 to 44, which accounted for 40% of the visits.
While the report reflected a pattern Robin Wisner has observed in the Portland area for years, the numbers showing the impact of gun injuries on Black Oregonians still proved staggering.
“It was mind-blowing to me,” said Wisner, a pastor and city council member in Maywood Park in east Portland.
Wisner has been active in youth gun violence prevention for decades and consulted with OHSU researchers on the report. He was a long-time member of the Portland Police Bureau’s Crisis Response Team, a group of on-call volunteers who respond to shooting scenes to offer support to victims and their families.
Wisner has experience with that kind of trauma. In 2002, his son was fatally shot during a dispute with a friend.
He says while the report is only the beginning of research into gun injuries, the data is important because it adds detail and evidence for what people are experiencing in the community.
“You need to be able to have the specifics of this epidemic to be able to prescribe the right antidote,” Wisner said.
He’s hopeful future reports include further examination of intentionality and the demographics of people injured so that prevention efforts, including mental health and social support for victims and at-risk people, are directed effectively.
Also, he’s pushing for more granular geographic data.
According to the analysis by the Portland Police Bureau, nonfatal injury shootings were concentrated in neighborhoods of north Portland and east Portland, where income levels are lower.
It’s too early in the research on gun injuries for the report to point to any specific prevention programs, but public health workers are always thinking about how data can inform life-saving measures, Carlson said.
“To develop any prevention program, you need baseline data, and that’s what these are,” she said. “Now we have this system developed and we’ll continue to enhance it.”
She added that the research center will serve as a hub to monitor whether any prevention programs already underway have any effect on the trends.
Amid the recent spike in gun injuries, traumatic injuries broadly have increased in the Portland area as well, said Dr. Martin Schreiber, division head for trauma, critical care and acute care surgery at OHSU. The increase is in line with the national trends, he said.
Furthermore, penetrating injuries (gun injuries and stab wounds) have increased proportionally with the overall increase in traumatic injuries ERs treat, Schreiber noted. The top two causes of traumatic injuries are vehicle crashes and injuries related to people falling. Penetrating injuries have stayed around 10% of all traumatic injuries, according to Schreiber. That’s while there’s been a 25% increase in the overall number of trauma patients going to OHSU’s hospital in the last two years, he said.
One gun injury is too many, Schreiber said, but the overall trends in traumatic injuries are important context, he added.
Additionally, while Portland had by far the highest increase in its homicide rate among five similarly sized cities, according to the Portland Police, data suggest Oregon still has among the lowest per capita rates of nonfatal gun injuries in the country.