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Racial and Ethnic Inequalities for Nonfatal Legal Intervention Injuries Treated in US Emergency Departments

PMCID: PMC12576483

PMID: 41165710

Abstract

This cross-sectional study explores racial and ethnic disparities in injuries caused by law enforcement and treated in US emergency departments (EDs) from 2004 to 2021.

Full Text

In NEISS-AIP, legal intervention includes an injury or poisoning caused by on-duty police or other legal authorities, including private security guards. NEISS-AIP offers an advantage over administrative claims data, which underreport substantial shares of legal intervention injuries. We used NEISS-AIP’s predefined race and ethnicity categories, which were derived from patient medical records (eAppendix in Supplement 1).
All analyses were performed between September 2024 and July 2025 using R software version 4.2 (R Project for Statistical Computing) with the survey and mgcv packages. We fit quasi-Poisson models for injury rates, treating year as a spline (for visualization) or as linear (to assess trends quantitatively), using parametric bootstrapping to construct CIs. We deemed any 95% CI for the linearized trend line that included the null value to be inconclusive as to its directionality, but we still interpreted the confidence limit as the bounds within which the trend was expect to fall. Additional methodological details are available in the eAppendix in Supplement 1.
Between 2004 and 2021, a total of 1 500 577 ED visits (95% CI, 1 073 632-1 927 522; 85% [95% CI, 60% to 100%] men; mean [SD] age, 33 [12] years) in the US were for legal intervention injuries. Among patients with race and ethnicity data, 42.3% (95% CI, 21.2% to 63.4%) were African American or Black, 13.9% (95% CI, 5.4% to 22.3%) were Hispanic or Latinx, and 41.1% (95% CI, 30.7% to 51.5%) were White. Most patients were treated and released, with only 4.3% (95% CI, 2.5% to 6.1%) requiring hospitalization (Table).
Legal intervention injury rates for the US population as a whole remained relatively stable over the study period (Figure), with the 2021 rate at 92% (95% CI, 71% to 119%) the level of the 2004 rate. Over the study period, mean injury rates for African American or Black people were 5.3 (95% CI, 4.6 to 6.2) times those of White people. Rates for Hispanic or Latinx people were 1.5 (95% CI, 1.2 to 1.7) times those of White people. While the point estimates for Black:White RR decreased by 6%, from 5.48 in 2004 to 5.13 in 2021, uncertainty was high, with the 95% CI ranging from a 42% reduction to 51% increase. For the Latinx population, the RR decreased from 1.94 in 2004 to 1.06 in 2021, corresponding to a 45% (95% CI, 12% to 66%) decrease.

Sections

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Metadata

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