Inequitable Aftermath: Structural Mechanisms Shaping the Experience of Firearm Violence

Background. The aftermath of firearm violence is shaped by the same structural conditions that determine exposure, yet their role in producing differential post-exposure experiences remains underspecified. This study identifies the mechanisms through which these conditions generate inequitable aftermath experiences across four exposure typologies. Methods. Secondary qualitative analysis of 33 in-depth interviews with adults who had experienced firearm violence (physical injury, witnessing, bereavement, chronic community violence) in the United States. Guided by intersectionality as a sensitizing framework, analysis used iterative coding, cross-case matrices, and temporal analysis. Results. Seven mechanisms were identified: financial foreclosure, racialized institutional stigma, institutional recognition hierarchy, navigation burden, temporal abandonment, agency suppression, and compounding exposure. Mechanisms operated across rather than within exposure typologies, compounded one another systematically, and shaped identity from within while constraining material access. Outlier analysis specified the structural conditions under which each mechanism was suppressed. Intersectional analysis found that race and class operated both distinctly and in combination, producing qualitatively distinct burdens not reducible to either axis alone. Conclusions. The inequitable aftermath of firearm violence is structurally produced, not inevitable. The mechanisms identified provide a framework for intervention that targets institutional design failures, racialized processes, and temporally bounded support systems rather than individual-level coping. Intersectional analysis further demonstrates that race and class compound one another in ways that single-axis frameworks cannot capture, with direct implications for how interventions are designed and for whom.