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Cited by 129Gun Ownership and Violence ResearchHomicide, Infanticide, and Child AbuseSuicide and Self-Harm Studies

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

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Rees, Chris A., Monuteaux, Michael C., Steidley, Isabella, Mannix, Rebekah, Lee, Lois K., Barrett, Jefferson T., Fleegler, Eric W.·2022·JAMA Network Open
DOI 10.1001/jamanetworkopen.2022.44221PMC PMC9709653
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Abstract

Importance: Firearm 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. Objective: To understand variations in rates of firearm fatalities stratified by intent, demographics, and geography in the US. Design, Setting, and Participants: This 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 Measures: Rates 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. Results: There 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 Relevance: This 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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  • The association between reinjury and SVI was not significant in the multivariable model due to the likelihood of SVI serving as a proxy for structural disparities and place-based racism among these young, Black men, resulting in high collinearity between SVI and both age and sex.

    “We believe the association between reinjury and SVI was not significant in the multivariable model due to the likelihood of SVI servings as a proxy for structural disparities and place-based racism among these young, Black men, resulting in high collinearity between SVI and both age and sex.53”

    From Incidence of and Factors Associated With Recurrent Firearm Injury Among Patients Presenting to St. Louis Trauma Centers, 2010 to 2019 (2023) · cites this paper as [53]

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References 43 · Cited by 129

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  1. [3]Goldstick JE, Zeoli A, Mair C, Cunningham RMUS. US firearm-related mortality: national, state, and population trends, 1999-2017. Health Aff (Millwood). 2019; 38(10): 1646- 1652. doi: 10.1377/hlthaff.2019.00258 31589525 PMC7028356 · DOI · Paper page
  2. [4]Lee LK, Mannix R. Increasing fatality rates from preventable deaths in teenagers and young adults. JAMA. 2018; 320(6): 543- 544. doi: 10.1001/jama.2018.6566 29852050 · DOI
  3. [6]Lee LK, Douglas K, Hemenway D. Crossing lines—a change in the leading cause of death among U.S. children. N Engl J Med. 2022; 386(16): 1485- 1487. doi: 10.1056/NEJMp2200169 35426978 · DOI
  4. [9]Schuster MA, Franke TM, Bastian AM, Sor S, Halfon N. Firearm storage patterns in US homes with children. Am J Public Health. 2000; 90(4): 588- 594. doi: 10.2105/AJPH.90.4.588 10754974 PMC1446208 · DOI
  5. [10]Azrael D, Cohen J, Salhi C, Miller M. Firearm storage in gun-owning households with children: results of a 2015 national survey. J Urban Health. 2018; 95(3): 295- 304. doi: 10.1007/s11524-018-0261-7 29748766 PMC5993703 · DOI · Paper page
  6. [12]Miller M, Zhang W, Azrael D. Firearm purchasing during the COVID-19 pandemic: results from the 2021 National Firearms Survey. Ann Intern Med. 2022; 175(2): 219- 225. doi: 10.7326/M21-3423 34928699 PMC8697522 · DOI
  7. [18]Jalal H, Buchanich JM, Roberts MS, Balmert LC, Zhang K, Burke DS. Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016. Science. 2018; 361(6408): eaau1184. doi: 10.1126/science.aau1184 30237320 PMC8025225 · DOI
  8. [19]Stewart K, Cao Y, Hsu MH, Artigiani E, Wish E. Geospatial analysis of drug poisoning deaths involving heroin in the USA, 2000-2014. J Urban Health. 2017; 94(4): 572- 586. doi: 10.1007/s11524-017-0177-7 28639058 PMC5533669 · DOI
  9. [20]Loop MS, Howard G, de Los Campos G,. Heat maps of hypertension, diabetes mellitus, and smoking in the continental United States. Circ Cardiovasc Qual Outcomes. 2017; 10(1): e003350. doi: 10.1161/CIRCOUTCOMES.116.003350 28073852 PMC5234692 · DOI
  10. [21]Wintemute GJ. The epidemiology of firearm violence in the twenty-first century United States. Annu Rev Public Health. 2015; 36: 5- 19. doi: 10.1146/annurev-publhealth-031914-122535 25533263 · DOI
  11. [22]Bailey HM, Zuo Y, Li F,. Changes in patterns of mortality rates and years of life lost due to firearms in the United States, 1999 to 2016: a joinpoint analysis. PLoS One. 2019; 14(11): e0225223. doi: 10.1371/journal.pone.0225223 31756227 PMC6874349 · DOI
  12. [23]Cunningham RM, Walton MA, Carter PM. The major causes of death in children and adolescents in the United States. N Engl J Med. 2018; 379(25): 2468- 2475. doi: 10.1056/NEJMsr1804754 30575483 PMC6637963 · DOI · Paper page
  13. [24]Karb RA, Subramanian SV, Fleegler EW. County poverty concentration and disparities in unintentional injury deaths: a fourteen-year analysis of 1.6 million U.S. fatalities. PLoS One. 2016; 11(5): e0153516. doi: 10.1371/journal.pone.0153516 27144919 PMC4856406 · DOI
  14. [25]Hoffmann JA, Farrell CA, Monuteaux MC, Fleegler EW, Lee LK. Association of pediatric suicide with county-level poverty in the United States, 2007-2016. JAMA Pediatr. 2020; 174(3): 287- 294. doi: 10.1001/jamapediatrics.2019.5678 31985759 PMC6990805 · DOI
  15. [26]Barrett JT, Lee LK, Monuteaux MC, Farrell CA, Hoffmann JA, Fleegler EW. Association of county-level poverty and inequities with firearm-related mortality in US youth. JAMA Pediatr. 2022; 176(2): e214822. doi: 10.1001/jamapediatrics.2021.4822 34807238 PMC8609463 · DOI
  16. [27]Degli Esposti M, Gravel J, Kaufman EJ, Delgado MK, Richmond TS, Wiebe DJ. County-level variation in changes in firearm mortality rates across the US, 1989 to 1993 vs 2015 to 2019. JAMA Netw Open. 2022; 5(6): e2215557. doi: 10.1001/jamanetworkopen.2022.15557 35666501 PMC9171565 · DOI
  17. [28]Pear VA, Castillo-Carniglia A, Kagawa RMC, Cerdá M, Wintemute GJ. Firearm mortality in California, 2000-2015: the epidemiologic importance of within-state variation. Ann Epidemiol. 2018; 28(5): 309- 315.e2. doi: 10.1016/j.annepidem.2018.03.003 29625814 · DOI
  18. [29]Tuan WJ, Frey JJ III. Wisconsin firearm mortality, 2000-2014. WMJ. 2017; 116(4): 194- 200. 29323805
  19. [30]Hawes AM, Chancellor KE, Rogers WR, Ledford JA. Fatal firearm injuries in Tennessee: a comparison study of Tennessee’s two most populous counties 2009-2012. J Forensic Sci. 2016; 61(3): 666- 670. doi: 10.1111/1556-4029.12834 27113699 · DOI
  20. [31]Beard JH, Morrison CN, Jacoby SF,. Quantifying disparities in urban firearm violence by race and place in Philadelphia, Pennsylvania: a cartographic study. Am J Public Health. 2017; 107(3): 371- 373. doi: 10.2105/AJPH.2016.303620 28103077 PMC5296702 · DOI
  21. [32]Riddell CA, Harper S, Cerdá M, Kaufman JS. Comparison of rates of firearm and nonfirearm homicide and suicide in Black and White non-Hispanic men, by U.S. state. Ann Intern Med. 2018; 168(10): 712- 720. doi: 10.7326/M17-2976 29710093 · DOI
  22. [33]Lee LK, Chaudhary S, Kemal S, Kiragu A, Sheehan K, Fleegler EW. Addressing the void: firearm injury prevention in the USA. Lancet Child Adolesc Health. 2022; 6(8): 515- 516. doi: 10.1016/S2352-4642(22)00158-4 35644160 PMC9135492 · DOI
  23. [35]Siegel M, Sherman R, Li C, Knopov A. The Relationship between racial residential segregation and Black-White disparities in fatal police shootings at the city level, 2013-2017. J Natl Med Assoc. 2019; 111(6): 580- 587. doi: 10.1016/j.jnma.2019.06.003 31256868 · DOI
  24. [37]Cockerham WC, Hamby BW, Oates GR. The social determinants of chronic disease. Am J Prev Med. 2017; 52(1S1): S5- S12. doi: 10.1016/j.amepre.2016.09.010 27989293 PMC5328595 · DOI · Paper page
  25. [40]Curtin SC, Warner M, Hedegaard H. Increase in suicide in the United States, 1999-2014. NCHS Data Brief. 2016;(241): 1- 8. 27111185
  26. [41]Pallin R, Spitzer SA, Ranney ML, Betz ME, Wintemute GJ. Preventing firearm-related death and injury. Ann Intern Med. 2019; 170(11): ITC81- ITC96. doi: 10.7326/AITC201906040 31158880 · DOI
  27. [42]Fleegler EW, Madeira JL. First, prevent harm: eliminate firearm transfer liability as a lethal means reduction strategy. Am J Public Health. 2020; 110(5): 619- 620. doi: 10.2105/AJPH.2020.305635 32267755 PMC7144432 · DOI
  28. [43]Azad HA, Monuteaux MC, Rees CA,. Child access prevention firearm laws and firearm fatalities among children aged 0 to 14 years, 1991-2016. JAMA Pediatr. 2020; 174(5): 463- 469. doi: 10.1001/jamapediatrics.2019.6227 32119063 PMC7052788 · DOI · Paper page
  29. [44]Fleegler EW, Lee LK, Monuteaux MC, Hemenway D, Mannix R. Firearm legislation and firearm-related fatalities in the United States. JAMA Intern Med. 2013; 173(9): 732- 740. doi: 10.1001/jamainternmed.2013.1286 23467753 · DOI
  30. [45]Lee LK, Fleegler EW, Farrell C,. Firearm laws and firearm homicides: a systematic review. JAMA Intern Med. 2017; 177(1): 106- 119. doi: 10.1001/jamainternmed.2016.7051 27842178 · DOI
  31. [46]Kegler SR, Simon TR, Zwald ML,. Vital signs: changes in firearm homicide and suicide rates—United States, 2019-2020. MMWR Morb Mortal Wkly Rep. 2022; 71(19): 656- 663. doi: 10.15585/mmwr.mm7119e1 35550497 PMC9098246 · DOI · Paper page
  32. [47]Barber C, Hemenway D. Too many or too few unintentional firearm deaths in official U.S. mortality data? Accid Anal Prev. 2011; 43(3): 724- 731. doi: 10.1016/j.aap.2010.10.018 21376860 · DOI
  33. [48]Rees CA, Lee LK, Fleegler EW, Mannix R. Mass school shootings in the United States: a novel root cause analysis using lay press reports. Clin Pediatr (Phila). 2019; 58(13): 1423- 1428. doi: 10.1177/0009922819873650 31496261 · DOI

Authors
Rees, C. A., Monuteaux, M. C., Steidley, I., Mannix, R., Lee, L. K., Barrett, J. T., & Fleegler, E. W.
Affiliations
  • Emory University (US)
  • Boston Children's Hospital (US)
  • Brown University (US)
  • Albert Einstein College of Medicine (US)
Corresponding author
Rees, Chris A.
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2022-11-29
Volume
5
Issue
11
Pages
e2244221
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2022.44221
PMC
PMC9709653
OpenAlex
W4310281835
Cited by
129
References
43
Citations by year
2026: 20 · 2025: 31 · 2024: 43 · 2023: 33 · 2022: 2
FWCI
20.92
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
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
firearm deaths, firearm homicide, firearm suicide, firearm injury prevention, racial and ethnic disparities, sex differences, age differences, urbanicity, county-level variation, temporal trends, United States, older men, rural counties, gun policy, gun safety education
MeSH terms
Cross-Sectional Studies, Female, Firearms, Homicide, Humans, Male, Suicide, United States, Wounds, Gunshot

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