Gun deaths leap after 15 years at plateau

David Heitz

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Gun deaths in the United States have trended up after several years at a plateau, according to a viewpoint published today in the Journal of the American Medical Association.

For about 15 years until 2014, gun deaths hovered at around 10.1 deaths per 100,000 person-years, according to the authors of the viewpoint. But in 2015 the statistics shot up to 11.3 deaths per 100,000 person years.

From 2016 to 2018, the most recent year for which statistics are available, gun deaths inched up further still to 11.8 per 100,000 person years.

The letter was signed by Jason Goldstick, Dr. Patrick Carter, and Dr. Rebecca M. Cunningham. The authors practice medicine at University of Michigan, Ann Arbor, in emergency medicine and injury prevention.

Guns ‘embedded within U.S. culture’

“More than 652,000 people in the U.S. died from firearm injuries between 1999 and 2018,” the authors reported. “Given that firearms are embedded within U.S. culture (in 2018, 21.9 percent of individuals owned a firearm and 35.2 percent lived in households with firearms) evidence-based public health measures and policies that enhance firearm safety are needed.”

There is no one size fits all to preventing firearms deaths, the researchers explained. “Firearm injuries are multifaceted; for example, there are nearly twice as many nonfatal firearm injuries as deaths, and assaults comprise a majority of nonfatal injuries while suicides comprise a majority of deaths.

“In this Viewpoint, we narrowed the scope to firearm mortality trends from 1999 to 2018 and current regional/demographic trends available from US Centers for Disease Control and Prevention.”

Rural suicides by firearm on the rise

In 2018, age-adjusted firearm mortality rates proved highest in more rural counties. “Age-adjusted firearm suicide rates increase with increasing county rurality, with rates per 100 000 person-years in the most rural counties more than two times those of urban counties (10.9 vs 4.8). Age-adjusted firearm homicides show less gradient across urbanicity categories, with rates 12.8 percent lower (4.1 vs 4.7) in the most rural counties compared with all others.

Childhood deaths by firearm increased 24.3 percent in the most rural counties from 2016 to 2018 but remained unchanged in urban counties.

“A large fraction of the firearm mortality burden falls on younger people, with 42.1 percent of all firearm decedents 35 years or younger in 2018,” the authors detailed.

“Among high school–aged youth (age 14-18 years), firearms are the leading cause of death (when examined by mechanism), with 10.19 deaths per 100 000 person-years, a rate more than 25 percent higher than traffic-related motor vehicle deaths, the next leading cause of death in this age group.”

Men most likely to die from guns

Most firearm deaths were male (85 percent). Of the gun-related homicides, 83.8 percent were men. Among the suicides, men comprised 86.4 percent of deaths.

“Given the lethality of suicide attempts, which have a case fatality rate of nearly 90 percent, lethal means intervention strategies must be prioritized, especially for rural U.S. regions,” the authors concluded.

“In comparison, firearm homicides occur at more similar per-capita rates in rural counties and in nonrural counties; there are promising strategies for interpersonal violence prevention and coupling those with available tools for risk stratification is critical and not only in urban areas.”

Public safety measures have reduced deaths from automobile crashes. Similar approaches must be taken with guns, the authors suggested.

“Successful public health approaches have been applied to reverse worsening mortality trajectories for other mechanisms of injury, such as motor vehicle crash,” the authors opined. “If a similar road map is followed with regard to firearm mortality, it may be possible to reverse the current trend and reset to a new, lower, endemic firearm mortality rate.”

Violence prevention must go beyond gun laws

In a separate viewpoint in today’s issue of JAMA Psychiatry the authors bemoan gun violence in the United States.

“In the U.S., the gun homicide rate is roughly 25 times higher and the gun suicide rate eight times higher than in other high-income countries,” the authors deride. “At times, gun violence may seem like a uniquely U.S. crisis that we cannot remedy, insurmountably tied into the very fabric of the nation—in effect, a public health problem of constitutional significance.”

Gun laws become mired in political deadlock. Researchers must explore new ways of curbing gun violence, the researchers said.

“Recent funding allocations for scientific research from both federal and private sources have opened new doors and legitimized gun violence research at major scientific agencies, such as the National Institutes of Health and the U.S. Centers for Disease Control and Prevention, which until very recently saw little if any such research as part of their scientific portfolios.

“The groundswell of scientists and junior investigators who are now emerging to study gun violence must use their newfound prominence to go beyond the pursuit of gun law evaluations to the discovery and testing of their own novel interventions.”

Innovative solutions already used to curb gun violence

“A scientific review of programs in 264 cities showed that every 10 additional nonprofit, community-building programs per 100,000 residents were associated with a 9 percent reduction in homicide and a 6 percent reduction in violence,” the authors observed. “Improving housing conditions and green space and generally enhancing neighborhood environments through programs, such as Horticultural Society LandCare Programs, have been associated with successes in reducing gun violence, injury, and death.”

Addressing the causes of suicide may prove more effective than trying to restrict access to guns. “Recent research has also found that home foreclosures are linked to rising suicide rates, and programs such as the Neighborhood Stabilization Program, which was established to provide emergency financial assistance to neighborhoods when rates of foreclosed or abandoned homes begin to rapidly increase, are other neighborhood interventions that may help decrease gun suicides,” the authors noted.

Access to mental health treatment also curbs suicide deaths. “Mental health interventions are also especially beneficial in reducing suicides, nearly two-thirds of which involve firearms in the U.S.,” the authors concluded. “The United States Air Force Suicide Prevention Program has resulted in a sustained reduction in suicides, as well as decreased rates of family violence, homicide, and unintentional death.

"Similarly, receipt of specialty mental health services in conjunction with a targeted suicide prevention program among adult members of a large health maintenance organization was associated with lower suicide rates over an 11-year period.”

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I've been in the news business 35 years, spending much of my career in editing roles at local newspapers in Los Angeles, Detroit, and the Quad-Cities of Illinois and Iowa. Upon moving to Denver in 2018, I began experiencing severe mental illness due to several traumatic experiences. I became homeless on the street for about a year before spending time in the state mental hospital. I am living proof that people can rebound from mental illness with proper treatment, even after experiencing homelessness. I consider myself a lucky guy to live in a great place like Denver. I hope my writing reflects the passion I have for living here.

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