Annals
Established in 1927 by the American College of Physicians

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21 January 2014 Annals of Internal Medicine Tip Sheet

Below is information about articles being published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.

1. Evidence conclusive that access to firearms significantly increases odds of suicide and homicide

Having a gun in the home significantly endangers the lives of the home's inhabitants, suggests an article being published in Annals of Internal Medicine. Researchers conducted a systematic review and meta-analysis of 15 published studies comparing the odds of being a victim of suicide or homicide between persons with and without access to firearms. All but one of the 15 studies reviewed reported significantly increased odds of suicide (odds ratio, 3.2) and homicide (odds ratio, 1.9) victimization associated with firearm access. The researchers limited their review to studies with individual-level data because their focus was individual effects of firearm accessibility. Population-level data was excluded due to concerns about ecological bias. For example, population-level data on household gun ownership may not reflect the persons who actually commit suicide so no true link between gun ownership and harms outcomes can be made, the authors explained. The author of an accompanying commentary asserts that the researchers' estimations are far too conservative and that exclusion of population-level data could display an equally misleading bias. The author sites population-based studies showing that places with higher levels of household gun ownership are associated with higher rates of firearm-related and overall suicide and that there is no other association between gun ownership levels and suicide by means other than guns. As for homicide, the author writes that population-level evidence indicates that a gun in the home increases the risk for homicide victimization for others in society, either due to someone in the family shooting others (for example, the Sandy Hook Elementary School shootings) or the gun being stolen by criminals. He concludes that "obtaining a firearm not only endangers those living in the home but also imposes substantial costs on the community."

2. Uninsured patients significantly less likely to be transferred between hospitals

Non-medical factors, including a patient's gender and insurance status, may influence care decisions and lead to potential health disparities, suggests an article being published in Annals of Internal Medicine. Federal law mandates that hospitals and physicians treat patients in need of emergency medical care regardless of race, ethnicity, sex, or ability to pay. Concerns persist that patients are transferred between hospitals for nonmedical reasons, but existing data are limited with virtually all studies focusing on the prehospital or emergency department settings. Researchers reviewed inpatient care data for 315,748 patients between the ages of 18 and 64 to examine the relationship between patients' insurance coverage and interhospital transfers for five common medical diagnoses: biliary tract disease, chest pain, pneumonia, sepsis and skin infection. The researchers found that uninsured hospitalized patients were significantly less likely to be transferred to another hospital for four of the five diagnoses when compared with privately insured patients, even after adjusting for demographic factors and severity of illness. Women were 35 to 40 percent less likely to be transferred than men for all five diagnoses. The researchers wrote that they were surprised by these findings but suspect that the lower transfer rate may be due to hospitals' unwillingness to accept uninsured patients when a transfer is requested. The authors write that more research is needed to understand why providers were also less likely to transfer women, but suspect that physicians may take symptoms in women less seriously than they do in men.