Importance Firearms caused more than 500 pediatric fatalities in 2017-a 50% increase from 2009. Laws regulating firearms are one approach to reducing pediatric firearm fatalities. Objective To evaluate the association between state child access prevention (CAP) firearm laws and pediatric firearm fatalities. Design, Setting, and Participants A state-level, cross-sectional study of CAP firearm laws throughout the United States, 1991-2016, was conducted using negative binomial regression to analyze differences in state fatality rates in children aged 0 to 14 years. Data analysis was performed from November 21, 2018, to October 18, 2019. Exposures Implementation of 2 categories of state CAP firearm laws: recklessness laws, which pertain to providing a firearm to a child, and negligence laws, which pertain to accessibility of a firearm within the home. Main Outcomes and Measures Rates of firearm fatalities across all intents and by specific intent (homicide, suicide, and unintentional) per 100 000 children aged 0 to 14 years. Results Twenty-five states passed CAP laws between 1989 and 2000. Between 1991 and 2016, 13 697 firearm fatalities occurred in children aged 0 to 14 years. Recklessness laws were not associated with changes in pediatric firearm fatality rates. Negligence laws overall were associated with significant reductions in firearm fatalities in children aged 0 to 14 years, with a 13% relative reduction in all firearm fatalities (95% CI, -18% to -7%), a 15% relative reduction in firearm homicides (95% CI, -22% to -7%), a 12% relative reduction in firearm suicides (95% CI, -20% to -2%), and a 13% relative reduction in unintentional firearm fatalities (95% CI, -24% to -1%). The most stringent negligence laws were associated with unintentional firearm fatality reductions of 59% (95% CI, -68% to -49%). A total of 3929 deaths (29% of all firearm deaths) were associated with states not having passed the most stringent form of negligence CAP laws. Conclusions and Relevance In this study, negligence laws were associated with relative reductions in firearm fatality rates in children aged 0 to 14 years. The most stringent negligence laws were associated with the largest reductions in unintentional firearm fatalities. Recklessness laws were not associated with reduced firearm fatality rates. The passage of negligence CAP laws may have the potential to reduce firearm fatalities in children.

中文翻译：

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1991 年至 2016 年 0 至 14 岁儿童的儿童接触预防枪支法律和枪支死亡人数

重要性 枪支在 2017 年造成了 500 多名儿科死亡，比 2009 年增加了 50%。管制枪支的法律是减少儿科枪支死亡的一种方法。目的评估州儿童接触预防 (CAP) 枪支法律与儿科枪支死亡之间的关联。设计、设置和参与者 1991-2016 年美国全国 CAP 枪支法律的州级横断面研究使用负二项式回归分析 0 至 14 岁儿童的州死亡率差异。数据分析时间为 2018 年 11 月 21 日至 2019 年 10 月 18 日。 暴露 2 类州 CAP 枪支法律的实施情况：涉及向儿童提供枪支的鲁莽法和涉及可获取枪支的疏忽法家中的枪支。主要结果和措施 每 100 000 名 0 至 14 岁儿童中所有意图和特定意图（他杀、自杀和非故意）的枪支死亡率。结果 25 个州在 1989 年至 2000 年间通过了 CAP 法律。1991 年至 2016 年间，0 至 14 岁儿童发生了 13697 起枪支死亡事件。鲁莽法律与儿科枪支死亡率的变化无关。总体疏忽法与 0 至 14 岁儿童的枪支死亡人数显着减少相关，所有枪支死亡人数相对减少 13%（95% CI，-18% 到 -7%），枪支死亡人数相对减少 15%凶杀案（95% CI，-22% 至 -7%），枪支自杀相对减少 12%（95% CI，-20% 至 -2%），非故意枪支死亡相对减少 13%（95%） CI，-24% 至 -1%）。最严格的疏忽法与非故意的枪支致死率降低 59%（95% CI，-68% 至 -49%）有关。共有 3929 人死亡（占所有枪支死亡人数的 29%）与未通过最严格形式的疏忽 CAP 法律的州有关。结论和相关性 在这项研究中，疏忽法与 0 至 14 岁儿童枪支死亡率的相对降低有关。最严格的疏忽法与最大程度地减少了非故意枪支死亡人数有关。鲁莽法律与降低枪支死亡率无关。疏忽 CAP 法律的通过可能有可能减少儿童的枪支死亡人数。共有 3929 人死亡（占所有枪支死亡人数的 29%）与未通过最严格形式的疏忽 CAP 法律的州有关。结论和相关性 在这项研究中，疏忽法与 0 至 14 岁儿童枪支死亡率的相对降低有关。最严格的疏忽法与最大程度地减少了非故意枪支死亡人数有关。鲁莽法律与降低枪支死亡率无关。疏忽 CAP 法律的通过可能有可能减少儿童的枪支死亡人数。共有 3929 人死亡（占所有枪支死亡人数的 29%）与未通过最严格形式的疏忽 CAP 法律的州有关。结论和相关性 在这项研究中，疏忽法与 0 至 14 岁儿童枪支死亡率的相对降低有关。最严格的疏忽法与最大程度地减少了非故意枪支死亡人数有关。鲁莽法律与降低枪支死亡率无关。疏忽 CAP 法律的通过可能有可能减少儿童的枪支死亡人数。疏忽法与 0 至 14 岁儿童的枪支死亡率相对降低有关。最严格的疏忽法与最大程度地减少了非故意枪支死亡人数有关。鲁莽法律与降低枪支死亡率无关。疏忽 CAP 法律的通过可能有可能减少儿童的枪支死亡人数。疏忽法与 0 至 14 岁儿童的枪支死亡率相对降低有关。最严格的疏忽法与最大程度地减少了非故意枪支死亡人数有关。鲁莽法律与降低枪支死亡率无关。疏忽 CAP 法律的通过可能有可能减少儿童的枪支死亡人数。