Association of County-Level Poverty and Inequities With Firearm-Related Mortality in US Youth

Barrett, Jefferson T.; Lee, Lois K.; Monuteaux, Michael C.; Farrell, Caitlin A.; Hoffmann, Jennifer A.; Fleegler, Eric W.

doi:10.1001/jamapediatrics.2021.4822

Cited by 63 publications

(41 citation statements)

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“…The increase in firearm fatalities has not been equally distributed geographically in the US. Prior study findings suggest that firearm-related suicides may be more common in more impoverished counties . The maps in our study may serve to demonstrate where interventions may be focused at the state and county level.…”

Section: Discussionmentioning

confidence: 65%

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Trends and Disparities in Firearm Fatalities in the United States, 1990-2021

et al. 2022

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ImportanceFirearm fatality rates in the United States have reached a 28-year high. Describing the evolution of firearm fatality rates across intents, demographics, and geography over time may highlight high-risk groups and inform interventions for firearm injury prevention.ObjectiveTo understand variations in rates of firearm fatalities stratified by intent, demographics, and geography in the US.Design, Setting, and ParticipantsThis cross-sectional study analyzed firearm fatalities in the US from 1990 to 2021 using data from the Centers for Disease Control and Prevention. Heat maps, maximum and mean fatality rate graphs, and choropleth maps of county-level rates were created to examine trends in firearm fatality rates by intent over time by age, sex, race, ethnicity, and urbanicity of individuals who died from firearms. Data were analyzed from December 2018 through September 2022.Main Outcomes and MeasuresRates of firearm fatalities by age, sex, race, ethnicity, urbanicity, and county of individuals killed stratified by specific intent (suicide or homicide) per 100 000 persons per year.ResultsThere were a total of 1 110 421 firearm fatalities from 1990 to 2021 (952 984 among males [85.8%] and 157 165 among females [14.2%]; 286 075 among Black non-Hispanic individuals [25.8%], 115 616 among Hispanic individuals [10.4%], and 672 132 among White non-Hispanic individuals [60.5%]). All-intents total firearm fatality rates per 100 000 persons declined to a low of 10.1 fatalities in 2004, then increased to 14.7 fatalities (45.5% increase) by 2021. From 2014 to 2021, male and female firearm homicide rates per 100 000 persons per year increased from 5.9 to 10.9 fatalities (84.7% increase) and 1.1 to 2.0 fatalities (87.0% increase), respectively. Firearm suicide rates were highest among White non-Hispanic men aged 80 to 84 years (up to 46.8 fatalities/100 000 persons in 2021). By 2021, maximum rates of firearm homicide were up to 22.5 times higher among Black non-Hispanic men (up to 141.8 fatalities/100 000 persons aged 20-24 years) and up to 3.6 times higher among Hispanic men (up to 22.8 fatalities/100 000 persons aged 20-24 years) compared with White non-Hispanic men (up to 6.3 fatalities/100 000 persons aged 30-34 years). Males had higher rates of suicide (14.1 fatalities vs 2.0 fatalities per 100 000 persons in 2021) and homicide (10.9 fatalities vs. 2.0 fatalities per 100 000 persons in 2021) compared with females. Metropolitan areas had higher homicide rates than nonmetropolitan areas (6.6 fatalities vs 4.8 fatalities per 100 000 persons in 2021). Firearm fatalities by county level increased over time, spreading from the West to the South. From 1999 to 2011 until 2014 to 2016, fatalities per 100 000 persons per year decreased from 10.6 to 10.5 fatalities in Western states and increased from 12.8 to 13.9 fatalities in Southern states.Conclusions and RelevanceThis study found marked disparities in firearm fatality rates by demographic group, which increased over the past decade. These findings suggest that public health approaches to reduce firearm violence should consider underlying demographic and geographic trends and differences by intent.

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Section: Discussionmentioning

confidence: 65%

“…Prior study findings suggest that firearm-related suicides may be more common in more impoverished counties. 24 , 25 , 26 , 27 The maps in our study may serve to demonstrate where interventions may be focused at the state and county level.…”

Section: Discussionmentioning

confidence: 99%

Trends and Disparities in Firearm Fatalities in the United States, 1990-2021

et al. 2022

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“…For example, multiple indicators (e.g., income inequality, unemployment, and housing and economic instability) are associated with risk for homicide and suicide ( 3 – 5 ). Youth firearm homicide and suicide rates have been associated with poverty at the county level ( 6 ), and the percentage of youths living in conditions of household poverty is higher among racial and ethnic minority populations ( 6 ). The economic and social challenges associated with the COVID-19 pandemic could have exacerbated such risks ( 2 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Vital Signs: Changes in Firearm Homicide and Suicide Rates — United States, 2019–2020

Kegler¹,

Simon²,

Zwald³

et al. 2022

MMWR Morb. Mortal. Wkly. Rep.

120

138

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Introduction The majority of homicides (79%) and suicides (53%) in the United States involved a firearm in 2020. High firearm homicide and suicide rates and corresponding inequities by race and ethnicity and poverty level represent important public health concerns. This study examined changes in firearm homicide and firearm suicide rates coinciding with the emergence of the COVID-19 pandemic in 2020. Methods National vital statistics and population data were integrated with urbanization and poverty measures at the county level. Population-based firearm homicide and suicide rates were examined by age, sex, race and ethnicity, geographic area, level of urbanization, and level of poverty. Results From 2019 to 2020, the overall firearm homicide rate increased 34.6%, from 4.6 to 6.1 per 100,000 persons. The largest increases occurred among non-Hispanic Black or African American males aged 10–44 years and non-Hispanic American Indian or Alaska Native (AI/AN) males aged 25–44 years. Rates of firearm homicide were lowest and increased least at the lowest poverty level and were higher and showed larger increases at higher poverty levels. The overall firearm suicide rate remained relatively unchanged from 2019 to 2020 (7.9 to 8.1); however, in some populations, including AI/AN males aged 10–44 years, rates did increase. Conclusions and Implications for Public Health Practice During the COVID-19 pandemic, the firearm homicide rate in the United States reached its highest level since 1994, with substantial increases among several population subgroups. These increases have widened disparities in rates by race and ethnicity and poverty level. Several increases in firearm suicide rates were also observed. Implementation of comprehensive strategies employing proven approaches that address underlying economic, physical, and social conditions contributing to the risks for violence and suicide is urgently needed to reduce these rates and disparities.

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“…But, some studies showed opposite findings [ 17 , 44 ]. Some studies, that analized the impact of the Australian Gun Buyback program and the Australian National Firearms Agreement on suicide mortality rates in the Australian population, showed that there was no statistically observable additional impact on suicide mortality attributable to firearms [ 45 , 46 ]. Consequently, although most researchers agree that there is evidence for the effectiveness of restricting access to firearm in prevention of suicide, the above studies suggest that a much more dimensional strategy to reduce firearm-related suicide deaths is needed.…”

Section: Discussionmentioning

confidence: 99%

Worldwide suicide mortality trends by firearm (1990–2019): A joinpoint regression analysis

et al. 2022

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Introduction Suicide by firearm is a major public health problem in many countries. But, studies that investigated the mortality of suicide by firearm on a global scale are still limited. The aim of this study was to assess the global, regional and national trends in mortality of suicide by firearm from 1990 to 2019. Method Mortality data of suicide by firearm was presented using the age-standardized rates (ASRs, expressed per 100,000). Joinpoint regression analysis was used to assess trends of mortality of suicide by firearm: the average annual percent change (AAPC) with the corresponding 95% confidence interval (95%CI) was calculated. Results A total of 52,694 (45,110 male and 7584 female) deaths of suicide by firearm were reported worldwide in 2019. The global ASR of suicide by firearm was six-fold higher in males than in females (1.15 per 100,000 and 0.19 per 100,000, respectively), and varied greatly across countries: the highest rates were in Greenland (24.52 per 100,000 and 2.69 per 100,000, respectively) and the United States of America (10.13 per 100,000 and 1.66 per 100,000, respectively), while the lowest rates (0.05 per 100,000 or less) were observed in China, Japan and Singapore. Globally, the mortality of suicide by firearm had a decreasing tendency from 1990 to 2019 in both sexes together (AAPC = -2.0% per year; 95%CI = -2.1 to -1.9). Conclusion Decreasing trends in mortality of suicide by firearm were observed in majority of countries across the world, but not in all. Future research should determine more effective ways to further reduce mortality of suicide by firearm.

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Association of County-Level Poverty and Inequities With Firearm-Related Mortality in US Youth

Cited by 63 publications

References 59 publications

Trends and Disparities in Firearm Fatalities in the United States, 1990-2021

Trends and Disparities in Firearm Fatalities in the United States, 1990-2021

Vital Signs: Changes in Firearm Homicide and Suicide Rates — United States, 2019–2020

Worldwide suicide mortality trends by firearm (1990–2019): A joinpoint regression analysis

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