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The Epidemic of Violence

Interpersonal violent injury is now pervasive in the United States, and trauma centers stand on the front lines of the epidemic. According to the Centers for Disease Control and Prevention, homicide was responsible for 16,121 deaths in 2013. This represents nearly 600,000 potential life years lost, giving credence to the concern that interpersonal violence disproportionately affects our young people. Homicide is the second leading cause of death in people 15-24 years of age and 3rd in those 25-34 years of age overall. Disadvantaged minority populations are disproportionately represented in this devastation. Homicide is the leading cause of death in African Americans aged 10-24 years old and the second leading cause of death among Hispanics. Fatalities from assault represent the tip of the iceberg; non-fatal injuries are believed to outnumber fatal injuries on the order of 100 to one. As a result of the tremendous societal affects of violent injury, Violence Prevention is considered a fundamental goal of "Healthy People 2020".

San Francisco has not escaped the toll of interpersonal violence. The Department of Public Health teamed with the San Francisco Injury Center and the Harvard School of Public Health's National Violent Injury Statistics System to create the Profile of Injury in San Francisco. In addition, Trauma Registry data from the city's only Level I Trauma Center, San Francisco General Hospital Medical Center, has added up-to-date surveillance information to characterize the issue in our city. The major findings are:

  • The number of homicides in San Francisco is on the rise, with 59 in 2000, 70 in 2003, and 89 in 2007.
  • San Francisco General Hospital Medical Center (SFGHMC), the only Level I Trauma Center in the city of San Francisco, treated 97% of the firearm victims.
  • In San Francisco, adolescents (ages 15-24) have the highest rates of non-fatal violent injury, primarily involving assaults, resulting in hospitalization. 
  • In 2006, SFGHMC treated 228 gunshot victims and 196 stab victims. There were nearly three times as many gunshot victims in 2006 than there were only 5 years prior. Over half the victims in 2006 were under the age of 25. Final data for 2007 preliminarily appears to be worst than 2006.
  • Gun shot wounds are the leading cause of traumatic death at SFGHMC.
  • Within 3 years, approximately 35% of assault victims are reinjured from another assault badly enough to require hospitalization.
  • Approximately 90% of assault victims between 15 and 30 years old, admitted to SFGHMC for their injuries, have a prior history of criminal activity.
  • African Americans in our city make up about 6% of the population but represent about 60% of the gun violence victims.
  • In 2001, the last year this data was rigorously compiled in the Profile of Injury, firearm assault victims had the most extensive length of stay at SFGHMC.
  • During that same year, health care charges to assault victims exceeded $23 million dollars. Greater than 60% of these charges are estimated to be covered by public funds.

Ethnic Disparities in Violent Injuries in San Francisco: Latino/a and African American communities in San Francisco have been hardest hit by interpersonal violence. According to the 2004 Profile of Injury in San Francisco, "the majority of assault victims in San Francisco were injured on the streets in the Inner Mission (48), South of Market (47) and Bayview/Hunters Point (31) neighborhoods." Recent data released from the San Francisco Police Department also indicates exact locations of homicide incidents, with major activity occurring in Visitation Valley, Bayview/Hunters Point, Ingleside, Potrero Hill, the Mission, and the Tenderloin districts.

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