We previously reported a more than 70% increase in firearm injuries during the first year of the COVID-19 pandemic, with disproportionate impacts on young Black and Hispanic men.1 We aimed to assess whether those pandemic-era surges have changed or maintained in recent years.
We studied the rate of firearm-related injury across more than 183 million emergency department (ED) visits in the U.S. between Q1 2018 and Q2 2025. Firearm injury diagnoses covered accidental, intentional, assault, undetermined, legal, and terrorism-related injuries.
Firearm injury rates rose sharply in Q2 2020 to 1.8 per 1,000 ED visits, doubling the Q2 2018 rate (0.9 per 1,000 ED visits). Rates declined in many quarters since and reached pre-pandemic levels by Q4 2023.
Firearm injury rates varied dramatically across age, sex, and racial/ethnic groups, with the highest rates concentrated among Black and Hispanic males aged 13 to 34. Black males aged 18 to 24 consistently experienced the highest injury rates. Before the COVID-19 pandemic, rates in this group remained below 15 per 1,000 ED visits in each quarter. However, rates in this group peaked at 25 per 1,000 ED visits in Q2 2020 and remained above 15 per 1,000 in many quarters since. Hispanic males in the same age group also had elevated rates during the pandemic, with a peak of 8.5 per 1,000 ED visits in Q3 2020, though rates have returned to pre-pandemic levels since.
Firearm injury rates also rose among female patients, particularly Black females aged 13 to 24, whose rates doubled during the pandemic and then declined some before stabilizing at levels higher than before 2020. However, firearm injury rates for Black females remain substantially lower than their male counterparts of the same age.
