State Firearm Laws and Interstate Firearm Deaths From Homicide and Suicide in the United States: A Cross-sectional Analysis of Data by County
Open accessAbstract
Importance: Firearm laws in one state may be associated with increased firearm death rates from homicide and suicide in neighboring states. Objective: To determine whether counties located closer to states with lenient firearm policies have higher firearm death rates. Design, Setting, and Participants: This cross-sectional study of firearm death rates by county for January 2010 to December 2014 examined data from the US Centers for Disease Control and Prevention for firearm suicide and homicide decedents for 3108 counties in the 48 contiguous states of the United States. Exposures: Each county was assigned 2 scores, a state policy score (range, 0-12) based on the strength of its state firearm laws, and an interstate policy score (range, -1.33 to 8.31) based on the sum of population-weighted and distance-decayed policy scores for all other states. Counties were divided into those with low, medium, and high home state and interstate policy scores. Main Outcomes and Measures: County-level rates of firearm, nonfirearm, and total homicide and suicide. With multilevel Bayesian spatial Poisson models, we generated incidence rate ratios (IRR) comparing incidence rates between each group of counties and the reference group, counties with high home state and high interstate policy scores. Results: Stronger firearm laws in a state were associated with lower firearm suicide rates and lower overall suicide rates regardless of the strength of the other states' laws. Counties with low state scores had the highest rates of firearm suicide. Rates were similar across levels of interstate policy score (low: IRR, 1.34; 95% credible interval [CI], 1.11-1.65; medium: IRR, 1.36, (95% CI, 1.15-1.65; and high: IRR, 1.43; 95% CI, 1.20-1.73). Counties with low state and low or medium interstate policy scores had the highest rates of firearm homicide. Counties with low home state and interstate scores had higher firearm homicide rates (IRR, 1.38; 95% CI, 1.02-1.88) and overall homicide rates (IRR, 1.32; 95% CI, 1.03-1.67). Counties in states with low firearm policy scores had lower rates of firearm homicide only if the interstate firearm policy score was high. Conclusions and Relevance: Strong state firearm policies were associated with lower suicide rates regardless of other states' laws. Strong policies were associated with lower homicide rates, and strong interstate policies were also associated with lower homicide rates, where home state policies were permissive. Strengthening state firearm policies may prevent firearm suicide and homicide, with benefits that may extend beyond state lines.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Restrictions on common means of suicide, such as detoxifying domestic gas, reducing alcoholic spirits availability, and state firearm restrictions, have been linked to changes in suicide rates.
“Changes in suicide rates have also been attributed to restriction of common means of suicide, such as detoxification of domestic gas (i.e., the reduction and eventual elimination of the carbon monoxide content of gas owing to a switch to natural gas) in the United Kingdom, starting in the 1960s,6 decreased availability of alcoholic spirits in Russia,7 and state restrictions of firearms in the”
From Suicide (2020) · cites this paper as [8]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Home visits: a strategy to improve newborn survival - Authors' reply
(2008) · Americanae (AECID Library) · doi:10.1016/s0140 · Cited by 22,524 · see citing works
Neighborhoods and Violent Crime: A Multilevel Study of Collective Efficacy
Sampson, R. J., Raudenbush, S. W., & Earls, F. (1997) · Science · doi:10.1126/science.277.5328.918 · Cited by 11,999 · see citing works
WinBUGS - A Bayesian modelling framework: Concepts, structure, and extensibility
Lunn, D. J., Thomas, A., Best, N., & Spiegelhalter, D. J. (2000) · Statistics and Computing · doi:10.1023/a:1008929526011 · Cited by 5,372 · see citing works
The Geography of Transport Systems
Rodrigue, J. (2020) · Routledge eBooks · doi:10.4324/9780429346323 · Cited by 3,060 · see citing works
Overadjustment bias and unnecessary adjustment in epidemiologic studies.
Schisterman, E. F., Cole, S. R., & Platt, R. W. (2009) · Epidemiology · doi:10.1097/ede.0b013e3181a819a1 · Cited by 2,096 · see citing works
Applied Spatial Statistics for Public Health Data
Waller, L. A., & Gotway, C. A. (2004) · Wiley series in probability and statistics · doi:10.1002/0471662682 · Cited by 1,611 · see citing works
The Geography of Transport Systems
Rodrigue, J., Comtois, C., & Slack, B. (2016) · Routledge eBooks · doi:10.4324/9781315618159 · Cited by 1,133 · see citing works
Lord, D., Washington, S. P., & Ivan, J. N. (2004) · Accident Analysis & Prevention · doi:10.1016/j.aap.2004.02.004 · Cited by 862 · see citing works
A New Set of Spatial-Interaction Models: The Theory of Competing Destinations
Fotheringham, A. S. (1983) · Environment and Planning A Economy and Space · doi:10.1177/0308518x8301500103 · Cited by 516 · see citing works
A comparison of Bayesian spatial models for disease mapping
Best, N., Richardson, S. T., & Thomson, A. (2005) · Statistical Methods in Medical Research · doi:10.1191/0962280205sm388oa · Cited by 512 · see citing works
Firearm injuries in the United States
Fowler, K. A., Dahlberg, L. L., Haileyesus, T., & Annest, J. L. (2015) · Preventive Medicine · doi:10.1016/j.ypmed.2015.06.002 · Cited by 499 · see citing works
Violent Death Rates: The US Compared with Other High-income OECD Countries, 2010
Grinshteyn, E. G., & Hemenway, D. (2015) · The American Journal of Medicine · doi:10.1016/j.amjmed.2015.10.025 · Cited by 416 · see citing works
Effects of Restrictive Licensing of Handguns on Homicide and Suicide in the District of Columbia
Loftin, C., McDowall, D., Wiersema, B., & Cottey, T. J. (1991) · New England Journal of Medicine · doi:10.1056/nejm199112053252305 · Cited by 399 · see citing works
SPATIAL STRUCTURE AND DISTANCE‐DECAY PARAMETERS
Fotheringham, A. S. (1981) · Annals of the Association of American Geographers · doi:10.1111/j.1467-8306.1981.tb01367.x · Cited by 354 · see citing works
The Epidemiology of Firearm Violence in the Twenty-First Century United States
Wintemute, G. J. (2014) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-031914-122535 · Cited by 309 · see citing works
Firearm Legislation and Firearm-Related Fatalities in the United States
Fleegler, E. W., Lee, L. K., Monuteaux, M. C., Hemenway, D., & Mannix, R. (2013) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.1286 · Cited by 306 · see citing works
Applied Spatial Statistics for Public Health Data
Diggle, P. J. (2005) · Journal of the American Statistical Association · doi:10.1198/jasa.2005.s15 · Cited by 290 · see citing works
Ludwig, J. (2000) · JAMA · doi:10.1001/jama.284.5.585 · Cited by 287 · see citing works
Homicide and suicide risks associated with firearms in the home: A national case-control study
Wiebe, D. J. (2003) · Annals of Emergency Medicine · doi:10.1067/mem.2003.187 · Cited by 253 · see citing works
Self-citationHandgun Regulations, Crime, Assaults, and Homicide
Sloan, J. H., Kellermann, A. L., Reay, D. T., Ferris, J. A. J., Koepsell, T. D., Rivara, F. P., Rice, C., Gray, L., & LoGerfo, J. P. (1988) · New England Journal of Medicine · doi:10.1056/nejm198811103191905 · Cited by 236 · see citing works
What Do We Know About the Association Between Firearm Legislation and Firearm-Related Injuries?
Santaella-Tenorio, J., Cerdá, M., Villaveces, A., & Galea, S. (2016) · Epidemiologic Reviews · doi:10.1093/epirev/mxv012 · Cited by 234 · see citing works
Chapman, S., Alpers, P., Agho, K., & Jones, M. (2006) · Injury Prevention · doi:10.1136/ip.2006.013714 · Cited by 230 · see citing works
Cross-Border Spillover: U.S. Gun Laws and Violence in Mexico
Dubé, A., Dube, O., & García‐Ponce, O. (2013) · American Political Science Review · doi:10.1017/s0003055413000178 · Cited by 216 · see citing works
Firearm Laws and Firearm Homicides
Lee, L. K., Fleegler, E. W., Farrell, C., Avakame, E. F., Srinivasan, S., Hemenway, D., & Monuteaux, M. C. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.7051 · Cited by 211 · see citing works
Centers for Disease Control and Prevention
Gellman, M. D., & Turner, J. R. (2013) · Springer eBooks · doi:10.1007/978-1-4419-1005-9_100268 · Cited by 196 · see citing works
Firearm legislation and firearm mortality in the USA: a cross-sectional, state-level study
Kalesan, B., Mobily, M. E., Keiser, O., Fagan, J. A., & Galea, S. (2016) · The Lancet · doi:10.1016/s0140-6736(15)01026-0 · Cited by 161 · see citing works
Effects of the Repeal of Missouri’s Handgun Purchaser Licensing Law on Homicides
Webster, D. W., Crifasi, C. K., & Vernick, J. S. (2014) · Journal of Urban Health · doi:10.1007/s11524-014-9865-8 · Cited by 159 · see citing works
Miller, M., Azrael, D. R., Hepburn, L. H., Hemenway, D., & Lippmann, S. (2006) · Injury Prevention · doi:10.1136/ip.2005.010850 · Cited by 153 · see citing works
Firearm Ownership and Suicide Rates Among US Men and Women, 1981–2013
Siegel, M., & Rothman, E. F. (2016) · American Journal of Public Health · doi:10.2105/ajph.2016.303182 · Cited by 149 · see citing works
Re-visiting crash–speed relationships: A new perspective in crash modelling
Imprialou, M.-I. M., Quddus, M., Pitfield, D. E., & Lord, D. (2015) · Accident Analysis & Prevention · doi:10.1016/j.aap.2015.10.001 · Cited by 131 · see citing works
Association Between Connecticut’s Permit-to-Purchase Handgun Law and Homicides
Rudolph, K. E., Stuart, E. A., Vernick, J. S., & Webster, D. W. (2015) · American Journal of Public Health · doi:10.2105/ajph.2015.302703 · Cited by 128 · see citing works
Firearms laws and the reduction of violence
Hahn, R. A., Bilukha, O. O., Crosby, A. E., Fullilove, M. T., Liberman, A., Mościcki, E. K., Snyder, S., Tuma, F. K., & Briss, P. A. (2005) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2004.10.005 · Cited by 125 · see citing works
Effects of changes in permit-to-purchase handgun laws in Connecticut and Missouri on suicide rates
Crifasi, C. K., Meyers, J. S., Vernick, J. S., & Webster, D. W. (2015) · Preventive Medicine · doi:10.1016/j.ypmed.2015.07.013 · Cited by 119 · see citing works
Reducing gun violence in America: informing policy with evidence and analysis
Webster, D. W. (2013) · Choice Reviews Online · doi:10.5860/choice.51-1167 · Cited by 116 · see citing works
Public Health Approach to the Prevention of Gun Violence
Hemenway, D., & Miller, M. (2013) · New England Journal of Medicine · doi:10.1056/nejmsb1302631 · Cited by 114 · see citing works
An evaluation of state firearm regulations and homicide and suicide death rates
Rosengart, M. R., Cummings, P., Nathens, A. B., Heagerty, P. J., Maier, R. V., & Rivara, F. P. (2005) · Injury Prevention · doi:10.1136/ip.2004.007062 · Cited by 100 · see citing works
Trends in Research Publications About Gun Violence in the United States, 1960 to 2014
Alcorn, T. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.7076 · Cited by 93 · see citing works
State background checks for gun purchase and firearm deaths: An exploratory study
Sen, B., & Panjamapirom, A. (2012) · Preventive Medicine · doi:10.1016/j.ypmed.2012.07.019 · Cited by 88 · see citing works
Temporary Transfer of Firearms From the Home to Prevent Suicide
McCourt, A. D., Vernick, J. S., Betz, M. E., Brandspigel, S., & Runyan, C. W. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.5704 · Cited by 84 · see citing works
The Association Between State Laws Regulating Handgun Ownership and Statewide Suicide Rates
Anestis, M. D., Khazem, L. R., Law, K. C., Houtsma, C., LeTard, R., Ringer, F. B., & Martin, R. L. (2015) · American Journal of Public Health · doi:10.2105/ajph.2014.302465 · Cited by 78 · see citing works
Barber, C. W., Frank, E., & Demicco, R. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.6712 · Cited by 73 · see citing works
Webster, D. W., Vernick, J. S., & Hepburn, L. M. (2001) · Injury Prevention · doi:10.1136/ip.7.3.184 · Cited by 71 · see citing works
Firearm Death Rates and Association with Level of Firearm Purchase Background Check
Sumner, S. A., Layde, P. M., & Guse, C. E. (2008) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2008.03.023 · Cited by 65 · see citing works
Effects of Limiting Handgun Purchases on Interstate Transfer of Firearms
Weil, D. S. (1996) · JAMA · doi:10.1001/jama.1996.03530460063033 · Cited by 60 · see citing works
Prevention of firearm-related injuries with restrictive licensing and concealed carry laws
Crandall, M. L., Eastman, A. L., Violano, P., Greene, W. R., Allen, S. L., Block, E. F. J., Christmas, A. B., Dennis, A. J., Duncan, T. K., Foster, S., et al. (2016) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/ta.0000000000001251 · Cited by 48 · see citing works
Effects of Maryland's Law Banning “Saturday Night Special” Handguns on Homicides
Webster, D. W., Vernick, J. S., & Hepburn, L. M. (2002) · American Journal of Epidemiology · doi:10.1093/aje/155.5.406 · Cited by 45 · see citing works
State background checks and firearms homicides
Ruddell, R., & Mays, G. L. (2005) · Journal of Criminal Justice · doi:10.1016/j.jcrimjus.2004.12.004 · Cited by 42 · see citing works
Kalesan, B., Vasan, S., Mobily, M., Villarreal, M. D., Hlavacek, P. R., Teperman, S. H., Fagan, J. A., & Galea, S. (2014) · BMJ Open · doi:10.1136/bmjopen-2014-005628 · Cited by 42 · see citing works
Getting Serious About Reducing Suicide
Swanson, J. W., Bonnie, R. J., & Appelbaum, P. S. (2015) · JAMA · doi:10.1001/jama.2015.15566 · Cited by 38 · see citing works
Effects of a Gun Dealer's Change in Sales Practices on the Supply of Guns to Criminals
Webster, D. W., Vernick, J. S., & Bulzacchelli, M. T. (2006) · Journal of Urban Health · doi:10.1007/s11524-006-9073-2 · Cited by 37 · see citing works
Suicide information database-Cymru
John, A. M., Dennis, M., Kosnes, L., Gunnell, D., Scourfield, J., Ford, D. V., & Lloyd, K. H. (2015) · Tesis Doctorals en Xarxa (Consorci de Serveis Universitaris de Catalunya) · doi:10.1136/bmjopen-2014 · Cited by 35 · see citing works
Chapman, S., Alpers, P., Agho, K., et al. (2015) · Injury Prevention · doi:10.1136/ip.2006.013714rep · Cited by 35 · see citing works
Wright, M. A., Wintemute, G. J., & Webster, D. W. (2010) · Journal of Urban Health · doi:10.1007/s11524-010-9437-5 · Cited by 33 · see citing works
Evaluating the Effect of State Regulation of Federally Licensed Firearm Dealers on Firearm Homicide
Irvin, N. A., Rhodes, K. V., Cheney, R., & Wiebe, D. J. (2014) · American Journal of Public Health · doi:10.2105/ajph.2014.301999 · Cited by 31 · see citing works
Self-citationVernick, J. S., Webster, D. W., Bulzacchelli, M. T., et al. (2006) · The Journal of Law Medicine & Ethics · doi:10.1111/j.1748-720x.2006.00097.x · Cited by 30 · see citing works
The Effect of Nondiscretionary Concealed Weapon Carrying Laws on Homicide
Hepburn, L. H., Miller, M., Azrael, D. R., et al. (2004) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/01.ta.0000068996.01096.39 · Cited by 29 · see citing works
Private-Party Gun Sales, Regulation, and Public Safety
Wintemute, G. J., Braga, A. A., & Kennedy, D. M. (2010) · New England Journal of Medicine · doi:10.1056/nejmp1006326 · Cited by 27 · see citing works
Stewart, R. M., & Kuhls, D. A. (2016) · The Journal of Trauma: Injury, Infection, and Critical Care · doi:10.1097/ta.0000000000001036 · Cited by 22 · see citing works
Vernick, J. S., Alcorn, T., & Horwitz, J. (2017) · The Journal of Law Medicine & Ethics · doi:10.1177/1073110517703344 · Cited by 20 · see citing works
Effects of limiting handgun purchases on interstate transfer of firearms
Weil, D. S. (1996) · JAMA · doi:10.1001/jama.275.22.1759 · Cited by 14 · see citing works
D’Agostino, R. B. (2005) · Encyclopedia of Biostatistics · doi:10.1002/0470011815.b2a13069 · Cited by 12 · see citing works
Does handgun legislation change firearm fatalities?
Beaver, B. L., Woo, S., Voigt, R. W., et al. (1993) · Journal of Pediatric Surgery · doi:10.1016/0022-3468(93)90222-7 · Cited by 9 · see citing works
Steinbrook, R., Stern, R. J., & Redberg, R. F. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.7180 · Cited by 6 · see citing works
Firearm Injuries and Gun Violence
Steinbrook, R., Stern, R. J., & Redberg, R. F. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.0937 · Cited by 5 · see citing works
Public health taking stronger approach to gun violence: APHA, Brady team up on prevention
Wahowiak, L. K. (2016) · The Nation's health · Cited by 2 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- United States Department of Justice. Federal Bureau of Investigation. Uniform Crime Reporting Program Data: County-Level Detailed Arrest and Offense Data, 2012 (ICPSR 35019). 2014. http://www.icpsr.umich.edu/icpsrweb/NACJD /studies/35019. Accessed November 29, 2016. 10.3886/ICPSR35019.v1. · DOI
Cited by
Sorted by citations
Fazel, S., & Runeson, B. (2020) · New England Journal of Medicine · doi:10.1056/nejmra1902944 · Cited by 502 · see citing works
- Authors
- Kaufman, E. J., Morrison, C. N., Branas, C. C., & Wiebe, D. J.
- Affiliations
- Weill Cornell Medicine (US)
- University of Pennsylvania (US)
- Columbia University (US)
- Corresponding author
- Kaufman, Elinore J.
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2018-05-01
- Volume
- 178
- Issue
- 5
- Pages
- 692
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC5885268
- OpenAlex
- W2792601441
- Cited by
- 91
- References
- 65
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 9 · 2023: 10 · 2022: 17 · 2021: 12 · 2020: 20 · 2019: 10 · 2018: 4 · 2016: 1
- FWCI
- 12.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- ScholarlyCommons (University of Pennsylvania) (submittedVersion, cc-by-nd)
- Funders
- Centers for Disease Control and Prevention (R49CE002474)
- Topics
- Social Sciences › Health › Gun Ownership and Violence Research
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Keywords
- law, firearm homicide, firearm suicide, gun policy, spatial spillover effects, homicide rates, suicide rates, gun control
- MeSH terms
- Cross-Sectional Studies, Female, Firearms, Homicide, Humans, Male, State Government, Suicide, United States
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
