O1028: Killed in Their Own Homes: The Rise of Pediatric Firearm In-Home Homicides and Association with State Firearm Laws

Background: Firearm-related injury is the leading cause of death for children and adolescents in the United States, with most deaths due to homicide. Prior research has demonstrated that one-quarter of child and adolescent homicides occur at home. Despite representing a major setting for pediatric mortality, it remains unknown how firearm laws, which vary widely across states, may affect rates of in-home pediatric homicide.

Methods: We used the 2005-2021 National Violent Death Reporting System and US Census data to conduct a repeated cross-sectional analysis of child and adolescent victims (0-17 years) of firearm-related homicide. We restricted analyses to 14 states that contributed continuously to NVDRS over this 17-year period. We assessed the state-based incidence of firearm-related homicide and firearm-related in-home homicide. We evaluated temporal trends with linear regression. We evaluated the association of in-home firearm-related homicide rates with the strength of state firearm laws as determined by the Giffords Law Center Gun Law Scorecard using Spearman’s Rank Correlation coefficient (ρ).

Results: From 2005-2021, there were 3,289 firearm-related homicides across 14 states, including 2,633 (80.0%) among teenagers aged 13-17 years and 656 (20.0%) among children aged 12 and younger. Of these, 27.5% (n=905) occurred at home including 17.4% (n=459) of teenage homicides and 68.0% (n=446) of child homicides. In-home homicides were more often associated with child abuse (11.2% [n=101] vs 1.2% [n=29]; p< 0.001) and intimate partner violence (20.8% [n=188] vs 4.3% [n=103]; p< 0.001).
From 2005-2021, the incidence of firearm-related homicide ranged from 0.69 homicides per 100,000 children and adolescents in 2013 to 1.82 homicides per 100,000 in 2021 (β=0.03; 95%CI -0.001-0.06; p=0.06). The incidence of in-home homicide ranged from 0.18 homicides per 100,000 in 2010 to 0.48 homicides per 100,000 in 2020 (β=0.01; 95%CI=0.01-0.01; p=0.02; Figure).
The incidence of firearm-related in-home homicide was lowest in Massachusetts ( < 0.10 deaths/100,000 children and adolescents) and highest in South Carolina (0.49 deaths/100,000). Increased strength of state firearm laws was correlated with lower rates of in-home firearm-related homicide (ρ=0.72; p=0.004). Extreme Risk laws have been passed in five of the seven states with the lowest rates of in-home homicide versus two of seven states with the highest rates of in-home homicide.

Conclusion: Over a quarter of firearm-related homicides among children and adolescents occurred at home, with rates of in-home homicide increasing during the study period. In-home homicides comprised over two-thirds of total homicides among children aged 12 and younger. Federal firearm laws may inadequately address the factors that precipitate these incidents like intimate partner violence and child abuse. With evidence that stronger state firearm laws are associated with fewer pediatric in-home homicides, future advocacy should seek to expand gun laws including extreme risk protection orders which may prevent these cases by removing firearms from high-risk households.