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Firearm injury deaths are identified from the California Department of Public Health (CDPH) California Comprehensive Master Death File (CCMDF). The CCMDF includes in-state deaths and deaths of California residents that occurred in other states or jurisdictions. It is derived from the death registration process and includes information from the death certificate, which is provided by informants and clinicians. For more information or to request data visit the CDPH Vital Records and Statistics Division (VRSD), formerly known as CHSI.
Emergency Department Visits & HospitalizationsInjury hospitalizations and emergency department (ED) visits are identified from the California Department of Health Care Access and Information (HCAI) Patient Discharge Data (PDD) and ED Data, respectively. The PDD include records of inpatient discharge from California-licensed hospitals, including general acute care, acute psychiatric, chemical dependency recovery, and psychiatric health facilities. The ED data include records of patient face-to-face encounters with providers at hospitals licensed to provide emergency medical services. If an ED encounter resulted in a same-hospital admission, the ED encounter would be combined with the PDD record and only appear as a hospitalization. For more information or to request data visit the California Department of Health Care Access and Information (HCAI).
Deaths - Standard Exclusions:
- Age unknown
- Age greater than 119
- Iatrogenic (has ICD-10 code of Y40-Y84, or Y88)
- Nonresidents - deaths where state of residence is not CA
- Age unknown
- Age greater than 119
- Encounters that were fatal
- Encounters for newborn
- Nonresidents - encounters where state of residence is not CA
Firearm injury deaths are identified from International Classification of Diseases, 10th Revision (ICD-10) codes appearing in the underlying cause of death field. The ICD-10 codes used to identify firearm injury deaths are listed in the table below. These codes include firearm injuries resulting from the discharge or malfunction of a firearm. They exclude injuries due to the discharge of air guns and paintball guns as well as strikes by firearms used as blunt objects.
Fatal firearm injury ICD-10 codes by intent| Intent | ICD-10 Codes |
|---|---|
| Unintentional | W32-W34 |
| Suicide/Self-harm | X72-X74 |
| Homicide/Assault | U01.4, X93-X95 |
| Undetermined | Y22-Y24 |
| Legal/War | Y35.0 |
Firearm injury ED visits and hospitalizations are identified from ICD-10, Clinical Modification (ICD-10-CM) codes appearing in any of 25 diagnosis fields and 12 external cause of morbidity fields. The ICD-10-CM codes used to identify firearm injuries are listed in the table below. These codes include firearm injuries resulting from the discharge or malfunction of a firearm. They exclude injuries due to the discharge of air guns and paintball guns as well as strikes by firearms used as blunt objects.
Nonfatal firearm injury ICD-10-CM codes by intent| Intent | ICD-10-CM Codes* |
|---|---|
| Unintentional | W32, W33, W34.00, W34.09, W34.10, W34.19 |
| Suicide/Self-harm | X72, X73, X74.8, X74.9 |
| Homicide/Assault | X93, X94, X95.8, X95.9, Y38.4 |
| Undetermined | Y22, Y23, Y24.8, Y24.9 |
| Legal/War | Y35.00-Y35.03, Y35.09, Y36.42, Y36.43, Y36.92, Y37.42, Y37.43, Y37.92 |
| * Only includes codes with a 7th character of A, B, C or missing (reflects initial encounter, active treatment) | |
The following variables are available for filtering and grouping injury data. Click on the variable to view the definition.
Severity is defined by the data source: death, hospital discharge or ED visit.
- Deaths are most severe.
- ED visits tend to be least severe.
Deaths: Intent is derived from the ICD-10 code. Table 1 in the Firearm Injury Case Definition section above lists the codes that correspond to each intent classification.
Hospitalizations and ED Visits: Intent is derived from the ICD-10-CM code. Table 2 in the Firearm Injury Case Definition section above lists the codes that correspond to each intent classification.
- Deaths: The calendar year of death.
- Hospitalizations: The calendar year the patient was discharged.
- ED Visits: The calendar year service was provided to the patient.
Victims aged 100 years or more are included in a 100+ category.
- Deaths: Age (in years) at time of death.
- Hospitalizations: Age of the patient (in years) at admission.
- ED Visits: Age of the patient (in years) at time of service.
Deaths: The decedents' sex primarily reflects the sex provided on the death certificate, which is often, but not always, a decedent's biological sex or sex assigned at birth. California law requires that individuals completing death certificates accurately record decedent’s sex to reflect the decendent's gender identity (“Respect After Death Act” AB 1577, 2014). “Other/Unknown” is used when sex is not recorded, unknown, or non-binary.
Hospitalizations and ED Visits: The patient’s biologic sex. “Other/Unknown” is used when sex is not recorded or in the case of undetermined sex and congenital abnormalities that obscure sex identification.
Race/ethnicity - Deaths, Hospitalizations, and ED Visits: Normalized race/ethnicity group based on a combination of reported race and ethnicity. Groups are defined as follows:
- American Indian/Alaska Native: Non-Hispanic American Indian/Alaska Native
- Asian: Non-Hispanic Asian
- Black: Non-Hispanic Black
- Hispanic: Hispanic ethnicity of any race
- Pacific Islander: Non-Hispanic Native Hawaiian or other Pacific Islander
- White: Non-Hispanic White
- Multiracial: Non-Hispanic and more than one of the five race groups listed above (White, Asian, Black, AI/AN, Pacific Islander)
- Other/Unknown: All other Non-Hispanic races and incomplete reporting
Note: For Hospitalizations and ED visits prior to 2019, the multiracial category was not available and Asian and Native Hawaiian/Pacific Islander were grouped together as a single category. For this reason, when filtering or grouping non-fatal injuries by race/ethnicity data are limited to 2019 and later.
Deaths: County of residence based on decedent’s address or as entered on the death certificate. “N/A (Unknown)” category is used when state residence is reported as California but county of residence is missing or unknown. Decedents with missing or unknown state and county of residence are excluded along with those residing outside California.
Hospitalizations and ED Visits: County of residence based on patient-reported ZIP Code. Unhoused patients without an identified county of residence are included under a “N/A (Unhoused)” category. Patients with unknown or missing ZIP codes are excluded along with those residing outside California.
Rates are calculated using population projections from the California Department of Finance’s Report P-3: Complete State and County Projections Dataset :
- Data years 2016 – 2019 use the Vintage 2020 release (2021.7.14).
- Data years 2020 – present use the Vintage 2023 release (2023.7.19). Please note: prior to December 2023, rates for data years 2020 and 2021 were calculated using the Vintage 2020 release. Rates currently shown for these years may differ from those that appeared on EpiCenter prior to December 2023.
The P-3 dataset includes population projections by year, age, sex, race/ethnicity, and county. Rates are not available for populations not included in this dataset, including education level, veteran status, expected payer (i.e., insurance type). Rates are also not available for other/unknown categories of populations included in the dataset (e.g., other/unknown sex, unhoused Californians). Additionally, rates are not available for hospital/ED facility county or region location because the source population (i.e., catchment area) is not clearly defined.
Due to differences in how race/ethnicity is reported in the population and injury data, caution should be used when interpreting rates involving race/ethnicity.
Because injuries are events that occur over time, incidence rates are used and expressed as injuries per 100,000 person-years. Person-years are the population multiplied by the number of years of observation. Incidence rates can be conceptualized as the number of events per 100,000 persons, per year. A thorough explanation of incidence rates can be found in Tenny & Boktor’s, "Incidence" StatPearls Article.
In compliance with the California Health and Human Services data de-identification guidelines, injury counts and rates will not be shown when the number of injuries and variable specificity may risk an individual being re-identified from the data. When this is the case, as determined by the Publication Scoring Criteria presented on page 16 of the guidelines, actual results are suppressed and replaced with an asterisk (*).
For additional injury data help, please email us at Violence.Prevention@cdph.ca.gov .
Data sources are largely mutually exclusive. You can view other California injury data on EpiCenter California Injury Data Online Dashboard.
Limitations
The firearm injury data presented are intended to provide a comprehensive count of injuries in California. There are, however,
important limitations:
Deaths
- Data come from death certificate information provided by informants and clinicians and may be subject to error.
- Firearm deaths are limited to California residents. They do not include injury deaths to non-residents that occurred in California.
- Due to dataset differences, to protect privacy, and prevent reidentification of individuals, disaggregated race and ethnicity data are not provided on the firearm dashboard but are available on EpiCenter. In instances where there are small counts of specified groups that would risk re-identification of individuals, the data available on EpiCenter will be masked according to CDPH Data De-Identification Guidelines.
Hospitalization and ED Visits
- The data only capture injuries treated at state-licensed hospitals and emergency medical services facilities. They do not include injuries treated in the outpatient setting or at federally licensed facilities, such as Veterans Affairs (VA) hospitals. They also do not capture injuries that go untreated.
- Injuries are identified through ICD-10-CM code, and are therefore only as accurate as the medical coding used to populate the data. Injuries treated at state-licensed facilities may be missed or misclassified if not accurately coded.
- Beginning in 2019, the number of external cause of morbidity fields in the non-fatal hospitalization and ED visit data was expanded from 5 to 12. This may result in more injuries being recorded starting in 2019.
- The data are limited to California residents treated in California. They do not include injuries to non-residents treated in California or injuries to California residents treated elsewhere.