Firearm Legislation and Firearm-Related Fatalities in the United States US Firearm Laws and Firearm-Related Fatalities

Fleegler EW, Lee LK, Monuteaux MC, et al. — Mon, 13 May 2013 00:00:00 GMT

Importance

Over 30 000 people die annually in the United States from injuries caused by firearms. Although most firearm laws are enacted by states, whether the laws are associated with rates of firearm deaths is uncertain.

Objective

To evaluate whether more firearm laws in a state are associated with fewer firearm fatalities.

Design

Using an ecological and cross-sectional method, we retrospectively analyzed all firearm-related deaths reported to the Centers for Disease Control and Prevention Web-based Injury Statistics Query and Reporting System from 2007 through 2010. We used state-level firearm legislation across 5 categories of laws to create a “legislative strength score,” and measured the association of the score with state mortality rates using a clustered Poisson regression. States were divided into quartiles based on their score.

Setting

Fifty US states.

Participants

Populations of all US states.

Main Outcome Measures

The outcome measures were state-level firearm-related fatalities per 100 000 individuals per year overall, for suicide, and for homicide. In various models, we controlled for age, sex, race/ethnicity, poverty, unemployment, college education, population density, nonfirearm violence–related deaths, and household firearm ownership.

Results

Over the 4-year study period, there were 121 084 firearm fatalities. The average state-based firearm fatality rates varied from a high of 17.9 (Louisiana) to a low of 2.9 (Hawaii) per 100 000 individuals per year. Annual firearm legislative strength scores ranged from 0 (Utah) to 24 (Massachusetts) of 28 possible points. States in the highest quartile of legislative strength (scores of ≥9) had a lower overall firearm fatality rate than those in the lowest quartile (scores of ≤2) (absolute rate difference, 6.64 deaths/100 000/y; age-adjusted incident rate ratio [IRR], 0.58; 95% CI, 0.37-0.92). Compared with the quartile of states with the fewest laws, the quartile with the most laws had a lower firearm suicide rate (absolute rate difference, 6.25 deaths/100 000/y; IRR, 0.63; 95% CI, 0.48-0.83) and a lower firearm homicide rate (absolute rate difference, 0.40 deaths/100 000/y; IRR, 0.60; 95% CI, 0.38-0.95).

Conclusions and Relevance

A higher number of firearm laws in a state are associated with a lower rate of firearm fatalities in the state, overall and for suicides and homicides individually. As our study could not determine cause-and-effect relationships, further studies are necessary to define the nature of this association.

Responding to the Crisis of Firearm Violence in the United States Comment on “Firearm Legislation and Firearm-Related Fatalities in the United States” Responding to the US Crisis of Firearm Violence

Wintemute GJ. — Mon, 13 May 2013 00:00:00 GMT

The United States has belatedly awakened to the knowledge that it is, in effect, under armed attack. More than 30 000 people are purposely shot to death each year—more than 300 000 since the World Trade Center was destroyed in 2001. Rates of firearm-related violent crime have increased 26% since 2008. Physicians have joined others in demanding a strong response to this crisis. We look to scientific research to provide the evidence on which that response should be based. Such evidence should include a thorough exploration of risk and protective factors and, most importantly, controlled studies showing which interventions work to reduce firearm violence and why.

AMA Publishing Group: Firearms Topic Collection

Firearm Legislation and Firearm-Related Fatalities in the United States US Firearm Laws and Firearm-Related Fatalities

Responding to the Crisis of Firearm Violence in the United States Comment on “Firearm Legislation and Firearm-Related Fatalities in the United States” Responding to the US Crisis of Firearm Violence