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The availability of firearms in a country was measured by noting the percentage of homicides committed using a firearm. This measure of gun availability was found to be positively associated with the suicide rate using firearms and negatively associated with the suicide rate using all other methods. The implications of these findings for suicide prevention are discussed.
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Firearm injuries significantly affect mortality rates in many states throughout the United States. We reviewed all deaths due to injuries in all state for 1985 to determine deaths from firearm injury in proportion to deaths from all injuries in each state. We then compared Texas data with those of other states. Death certificate data for Texas from 1976 through 1985 were used to describe Texas firearm mortality rates by age, gender, and race and to compare firearm injury with other causes of mortality in Texas. Texas ranked first among states in the proportion of injury deaths caused by firearms, with an annual firearm death rate of 21.2 per 10,000. Of the 30,906 firearm deaths recorded in Texas during the 10-year study period, 650 involved children. Black males had the highest firearm homicide rate (53.9 per 100,000 per year), and white males had the highest firearm suicide rate (15.7 per 100,000 per year). Firearms accounted for 11% of the total years of productive life lost. The economic cost of firearm deaths in Texas was estimated to be $40.7 billion per year. Strategies for preventing these deaths are discussed.
OBJECTIVE: To identify US counties (1) that had either significantly high or significantly low firearm homicide rates among black males 15 through 19 years of age in 1983 through 1985 and in 1987 through 1989, and/or (2) that experienced a significant increase in the firearm homicide rate between 1983 through 1985 and 1987 through 1989. DESIGN: Using the Compressed Mortality File, a county-level mortality and population database maintained by the National Center for Health Statistics, Centers for Disease Control, Hyattsville, Md, county-level firearm homicide rates are analyzed. SETTING: Eighty counties with a population of at least 10,000 black males 15 through 19 years of age in 1987 through 1989. SUBJECTS: Black males 15 through 19 years of age whose underlying cause of death was classified as firearm homicide (E965.0 through E965.4, or E970) in the ICD-9 (International Statistical Classification of Diseases, Injuries, and Causes of Death, Ninth Revision). MAIN OUTCOME MEASURE: County-specific firearm homicide rate. RESULTS: In 1983 through 1985 and in 1987 through 1989, seven and 13 counties, respectively, were identified that had significantly high firearm homicide rates. Firearm homicide rates were significantly high in both time periods in the following counties: Los Angeles, California; Wayne, Michigan; Kings, New York; St Louis City, Missouri; and Baltimore City, Maryland. Firearm homicide rates increased significantly between 1983 through 1985 and 1987 through 1989 in 34 of the 80 counties. Twenty counties had significantly low rates in both time periods. Several counties with low rates in 1983 through 1985 experienced significant increases and by 1987 through 1989 were among those with high rates. CONCLUSIONS: Surveillance of firearm homicide rates at the county levels in counties with high and with low rates is a necessary first step in the development of successful violence prevention programs. Those counties where rates are high and increasing are the counties that are in greatest need for intervention strategies. Knowledge of the incidence of nonfatal firearm injuries is also needed.
OBJECTIVE: To examine trends (1979 through 1989) and current status in firearm and nonfirearm homicide rates by level of urbanization among persons 15 through 19 years of age. DESIGN: The Compressed Mortality File, a county-level mortality and population database maintained by the National Center for Health Statistics, Centers for Disease Control, Hyattsville, Md, and the 1980 Human Resource Profile County Codes are used to analyze age-, sex-, and race-specific firearm and nonfirearm homicide rates by urbanization level. SETTING: United States, 1979 through 1989. SUBJECTS: Black and white males and females 15 through 19 years of age whose underlying cause of death was either firearm homicide (E965.0 through E965.4 or E970) or nonfirearm homicide (E960 through E964, E965.5 through E969, or E971 through E978) in the ICD-9 (International Statistical Classification of Diseases, Injuries, and Causes of Death, Ninth Revision). MAIN OUTCOME MEASURES: Urbanization level-specific firearm and nonfirearm homicide rates. RESULTS: The 1989 firearm homicide rate in metropolitan counties was nearly five times the rate in nonmetropolitan counties (13.7 vs 2.9 deaths per 100,000 population). Firearm homicide rates were highest in core metropolitan counties, 27.7 per 100,000 population; rates were higher for black males than for any other race-sex group in each of five county urbanization strata for 1979 through 1989. Nonfirearm homicide rates are considerably lower, with smaller urban differentials; the rate in metropolitan counties was 1.4 times the rate in nonmetropolitan counties (2.6 vs 1.8 per 100,000 population). From 1979 through 1984, firearm homicide rates declined in each of the county strata. From 1984 through 1987, firearm homicide rates increased, and from 1987 through 1989 they increased rapidly, from 23% to 35% per year in the four metropolitan strata. From 1979 through 1989, nonfirearm homicide rates declined or remained stable. CONCLUSIONS: Large urbanization differentials in firearm homicide and smaller differentials in nonfirearm homicide are identified. Firearm homicide rates are highest and increasing the fastest among black teenage males in the core, fringe, and medium metropolitan strata.
OBJECTIVE: To examine the rates of suicide by firearms in the five larger Australian States during 1968-1989, and to relate them to differences between those States. We hypothesised that (i) restrictive gun legislation will have reduced the firearms suicide rate in South Australia after 1980, and (ii) firearms suicides would be shown to be more common in States with larger rural:urban population ratios. DESIGN: Data supplied by the Australian Bureau of Statistics were analysed by sex, State and year of suicide. Differences between the firearms suicide rates of capital city and rural dwellers, and of different age-groups, were recorded. RESULTS: Firearms suicide rates in South Australia declined significantly after 1980, following proclamation of gun legislation, in contrast to the four other larger States where an increase in firearms suicides was recorded. The firearms suicide rate in Queensland has remained consistently higher than in the other four larger States during 1968-1989. The number of Australian firearms suicides per year fell by 25% from a peak of 572 in 1987 to 451 in 1989. CONCLUSIONS: Further reductions in the Australian firearms suicide rate might be achieved by tightening gun laws and by a media campaign aimed at reducing easy access by males to guns in rural households.
Firearms are a leading cause of death in the United States, yet the effort to understand their aggregate impact on the public's health has only just begun. There were 26,442 firearm deaths among California residents during the years 1977 through 1983. During this period firearms were the eighth leading cause of death for California as a whole, sixth for male Californians and first for black males aged 15 to 34 years and black females aged 15 to 24 years. A plurality of firearm deaths were suicides; unintentional deaths contributed only 3% of the total. Black men aged 25 to 34 years had the single highest firearm mortality rate; 80% of firearm deaths in that group were homicides. Men 75 years old and older had the highest firearm mortality rate when all races were considered together, however, and 93% of firearm deaths in that group were suicides. The discussion focuses on our current understanding of firearms as a medical and public health problem and suggests directions for future research and intervention.
We present the epidemiologic history of firearms in the United States. Firearms are among the nation's ten leading causes of death. Nearly one million firearm deaths occurred in the half-century 1933-1982. Suicide is the leading type of firearm death. Teenagers, young adults, and males 75 years old and older are currently at highest risk. An individual's risk of suffering a firearm death has generally risen with age. Increased firearm availability is associated with increased rates of firearm homicide and suicide. Strategies to prevent firearm deaths and injuries should be formulated in light of these findings, and heightened efforts to design, implement, and evaluate preventive measures are urgently needed.
Firearm injury mortality rates have been characterized in various settings, but little is known of the total magnitude of firearm injury, including morbidity. The authors determined population-based incidence rates of firearm injury among residents of Galveston, Texas, from 1979-1981 by using police, emergency department, hospital, emergency medical services, medical examiner, and vital records to identify 239 firearm injury cases. Vital records, medical examiner, and police records each identified more than 95% of the fatalities, but police records (sensitivity = 98%) were better than emergency department or hospital records (sensitivity = 82% and 28%, respectively) for identifying all nonfatal cases. The annual age-adjusted incidence rate of firearm injury was 128 per 100,000 persons. Black males, with the highest firearm injury rate (459 per 100,000 persons), were injured at 46 times the rate of white females (10 per 100,000 persons). The overall case fatality rate was 30%, including 25% of the assaults/homicides, 81% of the parasuicides/suicides, and 0% of the unintentional injuries. On the basis of the case fatality rates, an estimated 140,000 firearm injuries occur in the United States annually. The case fatality rate for penetrating head injuries was 80% versus 48% for chest injuries and 6% for all other parts of the body. The results are discussed with respect to policy recommendations for reducing firearm injuries.
Firearms claim more than 30,000 lives each year in the United States. In 1988 more than half of these deaths were among ages 1-34, with firearms accounting for 15 percent of all deaths in this age group. Total firearm deaths, as well as firearm homicide rates, have been increasing since 1984, taking a disproportionate toll on America's minority youth. The firearm homicide rate among all adolescents aged 15-19 rose 67 percent between 1984 and 1988. Among blacks aged 15-24, the firearm homicide rate was 72.0 per 100,000 during 1986-88 versus 8.1 among white males of this age. Geographic differences also exist, with Texas, California and New York leading in firearm homicides among white males aged 15-24, and Michigan, D.C., and California leading among blacks of this age.
The present studied explored the validity of several indirect measures of firearm ownership in the states of the USA: the percentage of homicides and suicides committed with firearms, the accidental death rate from firearms, the strictness of state handgun control laws, and subscription rates to firearm magazines. These measures were then correlated with rates of suicide and homicide, and it was found that states with a greater availability of firearms had higher firearm suicide rates and higher firearm homicide rates.
To study the epidemiology of deaths involving firearms kept in the home, we reviewed all the gunshot deaths that occurred in King County, Washington (population 1,270,000), from 1978 through 1983. The medical examiner's case files were supplemented by police records or interviews with investigating officers or both, to obtain specific information about the circumstances, the scene of the incident, the type of firearm involved, and the relationship of the suspect to the victim. A total of 743 firearm-related deaths occurred during this six-year period, 398 of which (54 percent) occurred in the residence where the firearm was kept. Only 2 of these 398 deaths (0.5 percent) involved an intruder shot during attempted entry. Seven persons (1.8 percent) were killed in self-defense. For every case of self-protection homicide involving a firearm kept in the home, there were 1.3 accidental deaths, 4.6 criminal homicides, and 37 suicides involving firearms. Hand-guns were used in 70.5 percent of these deaths. The advisability of keeping firearms in the home for protection must be questioned.
OBJECTIVE: To determine the characteristics of victims killed by firearms, whether they died by suicide, homicide or accident, and the types of firearms involved. DESIGN: A retrospective and descriptive study. SETTING AND SUBJECTS: Coronial autopsy data were obtained from the Brisbane Laboratory of Pathology and Microbiology. All 587 firearm deaths during the period 1980-1989 were included. MAIN OUTCOME MEASURES: The proportions of deaths by suicide, homicide, accident or undetermined cause. In cases of homicide, we sought to define the relationship of the perpetrator to the victim. RESULTS: The types of death were suicide 76%, homicide 18%, accidents 3% and undetermined 3%. Most homicides were of a domestic nature as opposed to crime. Small calibre rifles were the most common weapon; handguns were rarely used. CONCLUSIONS: Recent debate regarding firearm legislation has failed to recognise the predominance of interpersonal and psychological issues in the causation of firearm deaths. Crime is a motive for only a minority. Medical practitioners may reduce firearm deaths both by organisational representation and individual efforts in clinical practice. In particular, attention should be given to the identification of individuals or families at risk, the detection and treatment of psychological disorder and advice regarding firearm disposal.
STUDY HYPOTHESIS: Risk factors associated with unintentional gunshot fatalities among children include gender and race of the decedent, type of firearm used, and whether loaded guns are stored within the home. STUDY POPULATION: All New Mexico children 0 to 14 years old unintentionally killed by a firearm between 1984 and 1988. METHODS: The New Mexico Office of the Medical Investigator master mortality file was reviewed retrospectively to identify all unintentional firearm fatalities occurring in New Mexico children during a five-year period. Medical investigator, autopsy, and police reports were analyzed to identify epidemiologic factors associated with these deaths. Chi-square and Fisher's exact tests were used to analyze the data. RESULTS: Twenty-five unintentional firearm fatalities were identified. These deaths occurred most frequently among children playing with loaded firearms found within the home. A disproportionate number involved handguns. CONCLUSIONS: The study results provide a basis for preventive strategies that limit accessibility or decrease lethality of loaded firearms within the home.
Australia has a moderate overall suicide rate but an extremely high male firearm suicide rate. Using data covering the years 1961-1985, a series of multiple regression based analyses were performed. During this period, overall suicide rates fell but firearm suicides remained constant with a resulting increase in the proportion of suicides by firearms. There has been an increase in suicides in the young offset by a decline in the elderly. Young males showed the greatest proportional increase in the use of firearms. A limited regional analysis supported the hypothesis that lack of legislative restrictions on long guns in Queensland with a greater household prevalence of such weapons and different cultural attitudes were associated with higher overall and firearm suicide rates. Such findings are consistent with reports from North America, although trends in Australia are more modest. Reducing the availability and cultural acceptance of firearms is likely to decrease suicide rates, especially in males.
Members of the Maryland Chapter of the American Academy of Pediatrics completed a mail survey on their beliefs and counseling practices related to firearm injury prevention. Respondents were skeptical of the protective value of firearms in the home and most were supportive of gun control measures. Only a fifth believed that most families with handguns keep them inaccessible to children; however, many seemed to believe that the children at risk were in practices other than their own. Among those providing direct ambulatory care, 40% had had a patient who had been shot. Seventy-four percent believed pediatricians have a responsibility to counsel families about firearms. Only 13% believed parents would be offended if guns were included in anticipatory guidance discussions. Even so, only 30% had ever provided such counseling. Just half of the respondents agreed that they knew what to tell families about firearms. Ninety percent were very likely to counsel parents to store guns unloaded and locked up, whereas 54% were very likely to advise parents to remove guns from the home. More than two thirds believed parents would heed their advice about storing firearms, and 30% believed parents would follow advice about having guns. Results suggest pediatricians are ready to counsel about firearm injury prevention, but are not yet doing so.
We reviewed the available data on firearm-related injuries in Canada to suggest strategies for prevention in the context of the proposed amendments to the Criminal Code (Bill C-17) currently before Parliament. The risk of death from a firearm in Canada is equivalent to the risk of death from a motor vehicle crash. We discuss the risks associated with firearms with regard to suicides, homicides and "accidents." We also discuss the accessibility of firearms. This article builds upon a recently published update on the epidemiologic basis of the public health approach for the prevention of firearm-related injuries and deaths. The key to the etiologic approach to preventing such injuries and deaths is to view the incidents, regardless of their medicolegal circumstances, as having one factor in common: the discharge of a firearm.
Although firearms are significant contributors to intentional and unintentional injuries among children in Texas, little information has been published on this topic. We reviewed all firearm-related deaths occurring among persons younger than 15 years of age in Texas from 1984-1988. There were 337 firearm-related deaths among Texas children 0-14 years of age in this 5-year period. Unintentional deaths and firearm homicides were approximately equal for this age group. Black males ages 10-14 years were at highest risk of firearm-related death. The death rate for males was three times that of females. Death rates from unintentional shootings were highest in rural areas, while firearm homicides and suicides were highest in the largest cities.