AMERIKA GUN FETISH KILLS
Gun deaths more likely in small towns than major cities
Contrary to popular belief, firearm deaths in the U.S. are statistically more likely in small towns, not major cities, according to new research. Across the country, gun suicides are more common than gun homicides, and gun suicides are largely responsible for an increase in gun deaths over the past few decades, the study also finds.
The analysis of two decades of U.S. mortality data was conducted by researchers at Columbia University Mailman School of Public Health, Children’s Hospital of Philadelphia, and the University of California, Davis, and appears in the journal JAMA Surgery.
“Our study has found that the divide in total intentional firearm deaths between urban and rural counties is increasing, with rural counties bearing more of the burden. In the 2000s, the two most rural county types had statistically more firearm deaths per capita than any other county type, and by the 2010s, the most urban counties—cities—were the safest in terms of intentional firearm death risk,” the authors write.
“Despite the pervasive nature of gun violence, high rates of gun homicide in urban centers have been the sole focus of many policymakers and used as justification to loosen gun laws, when in fact gun violence is an issue in counties of all sizes,” the authors add.
More About the Findings
Gun suicides outnumber gun homicides each year in the U.S., and the risk of gun suicides in the most rural counties exceeds the risk of gun homicides in the most urban counties.
Between 2001 and 2010, the two most rural counties had higher total firearm death rates than the most urban counties. The most rural counties had a 25 percent higher overall firearm death rate than the most urban counties, a 54 percent higher gun suicide death rate, and a 50 percent lower gun homicide death rate compared with the most urban counties.
Previous research from the 1990s found that there was no difference in total intentional firearm deaths between the most urban and rural counties in the 1990s. The current study finds that the divide in total intentional firearm deaths between urban and rural counties is increasing, with rural counties bearing a great deal more of the burden.
The researchers based their findings on an analysis of multiple cause-of-death data files from the National Center for Health Statistics’ National Vital Statistics System over two decades, from the beginning of 2001 to the end of 2020.
The study’s authors are Paul M. Reeping, PhD (University of California, Davis; previously Columbia Mailman); Allison Mak, MD (University of Pennsylvania); Charles C. Branas, PhD (Columbia Mailman); Ariana N. Gobaud, MPH (Columbia Mailman); and Michael L. Nance, MD (University of Pennsylvania). Multiple authors are also part of the Columbia Scientific Union for the Reduction of Gun Violence (SURGE).
Funding was provided by a grant from the Centers for Disease Control and Prevention (R49CE003094). The authors declare no conflicts.
JOURNAL
JAMA Surgery
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Firearm Death Rates in Rural vs Urban US Counties
ARTICLE PUBLICATION DATE
26-Apr-2023
Three US regions hit the hardest by deaths of despair since 2010
Co-occurring clusters of suicide, overdose, and liver disease mortalities identified in the US west, southeast, and Appalachia/rust belt, report investigators in the American Journal of Preventive Medicine
Peer-Reviewed PublicationIMAGE: COUNTY RELATIVE RISK AND GEOGRAPHIC LOCATION OF SPACE-TIME CO-OCCURRING CLUSTERS OF DEATHS OF DESPAIR IN THE UNITED STATES, 2000-2019. view more
CREDIT: AMERICAN JOURNAL OF PREVENTIVE MEDICINE
Ann Arbor, April 26, 2023 – A new study in the American Journal of Preventive Medicine, published by Elsevier, identified three overlapping clusters of deaths of despair (i.e., suicide, overdose, and chronic liver disease and cirrhosis deaths) across the United States since 2010. Noting the sharp increase in deaths of despair documented in recent years, the investigators analyzed mortality data for individuals 10 years of age or older from 2000-2019 to detect geographic and temporal patterns. The findings showed six suicide clusters, four overdose clusters, nine alcohol-related liver disease clusters, which coincided in three large areas of the US west, southeast, and Appalachia/rust belt.
“Knowledge of geographic areas where suicide, overdose, and liver disease deaths are higher than expected, and where they coincide over multiple years, can help identify persistent clusters of deaths of despair that warrant public health intervention and continued or enhanced surveillance. Understanding which communities are at risk for co-occurring deaths of despair can assist public health entities to advocate for resources and funding to address the burden of mortality,” explained lead investigator Danielle L. Steelesmith, PhD, Center for Suicide Prevention and Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA.
Overall, mortality rates in the US have been increasing since hitting an all-time low in 2014. Life expectancy stopped trending upward in this period. These developments correspond with the surge in deaths of despair, which increased from 22.7 to 45.8 per 100,000 persons from 2000 to 2017. Overdoses increased the most, but suicides and liver deaths were also on the rise.
Little research has examined how the different categories of deaths of despair map out geographically and within specific timeframes. This project is the first to employ the relatively new and innovative methodology of co-occurring clusters to better understand how the different components interact and cluster together. The clusters identified for each type of death align with the times and places noted in prior research. When the specific clusters were mapped out together, three large intersecting areas stood out, in the west (counties in Wyoming, Montana, Colorado, Idaho, Utah, and New Mexico), southeast (counties in Florida, Georgia, South Carolina, North Carolina, Mississippi, Alabama, Louisiana, Tennessee, Kentucky, and Illinois) and throughout Appalachia/rust belt regions (counties in West Virginia, Virginia, Ohio, Indiana, Michigan, Delaware, Maryland, Pennsylvania, and western New York).
“Our findings highlight specific regions and counties at increased risk for these deaths that can be analyzed further to improve our understanding of why deaths of despair have been increasing. In addition, we identified certain areas of concern outside of the co-occurring clusters, such as a growing suicide rate in Maine, New Hampshire, and Vermont, an excess of liver disease deaths in Rhode Island, and an alarming number of overdoses in eastern Oklahoma. These regions would benefit from more targeted interventions and prevention efforts,” added Dr. Steelesmith.
JOURNAL
American Journal of Preventive Medicine
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Spatiotemporal Patterns of Deaths of Despair Across the United States, 20002019
Social vulnerability has direct link to suicide risk, study shows
Statistical analysis shows that measures of social determinants of health are associated with higher rates of suicide at the county level in the US, providing the opportunity to intervene and prevent deaths.
Peer-Reviewed PublicationMore than 45,000 Americans died by suicide in 2020, a 30% increase over 2000, making it the 12th leading cause of death in the U.S. Studies have shown that the social and environmental factors where people live, like exposure to violence and crime, access to quality health care, food insecurity, job opportunities, and air pollution, are connected to suicide rates.
Now, a new research study from the University of Chicago provides more statistical evidence that social determinants of health are tightly linked to suicide risk. The study, published in JAMA Network Open, shows that the suicide rate nearly doubled between the least socially vulnerable counties and the most socially vulnerable, clearly showing that programs designed to address health and economic disparities in these areas could prevent needless deaths.
“A huge factor in the rate of suicide in the United States is social vulnerability of the community that you live in,” said Robert Gibbons, PhD, the Blum-Reise Professor of Medicine and Public Health Sciences at UChicago and senior author of the study. “A doubling in the suicide rate is an earthquake. It’s enormous. If you can stratify risk and know that people in a community are going to be that much more at risk, that’s huge because you can target interventions to those communities.”
The study began as a class project for a course Gibbons teaches in statistical applications for graduate students and undergrads. A previous class looked at associations between lithium in ground water and diagnoses of bipolar disorder and dementia in the U.S., which was published in JAMA Psychiatry in 2018.
The new project built upon recent work published in Health Services Research by Loren Saulsberry, PhD, Assistant Professor of Public Health Sciences, Diane Lauderdale, Professor and Chair of Public Health Sciences, Gibbons, and others, that developed a new metric for measuring social determinants of health called the Social Vulnerability Metric (SVM). The SVM pulls in more than 200 variables from 17 publicly available, nationally representative databases focusing on demographics like age, education, employment status, housing and transportation, and health insurance coverage. The resulting model produces a score that summarizes a person’s vulnerability due to social risk factors and provides a measure of how able one might be to weather different events or cope with long-term challenges. The SVM is highly correlated with mortality rates at the county level, and it tracked with zip code level outcomes like COVID-19 mortality and vaccination rates, and emergency room visits for asthma.
Gibbons’ students divvied up the statistical work to see how the SVM was associated with suicide rates, using publicly available data on deaths by suicide provided by the Centers for Disease Control (CDC) for 2016 to 2020. Shuhan Liu, who is a master’s student in statistics at UChicago and recently accepted in the doctoral program in statistics at Northwestern University, led the analytical work, and Samuel Morin, a fourth-year undergraduate at UChicago, spearheaded work to extract data from the CDC sources.
The team calculated SVM scores for U.S. counties and divided them into 10 tiers from the least vulnerable counties to the most. They saw an 82% increase in suicide rate from the lowest to highest tier, as measured by the SVM. The team also evaluated another tool developed by the CDC called the Social Vulnerability Index (SVI), that measures the impact of social determinants of health. There was a 56% increase in suicide rate from the lowest to highest risk group according to this measure.
Gibbons said this shows an undeniable link between the impact of these factors and suicide. “We didn’t want to make any assumptions that the social vulnerability metric and its relationship to suicide was a simple linear function in our analysis of the data, but it turns out the higher the SVM, the higher the rate of suicide.”
The research team proposes several common-sense public health and economic policies that could reduce suicide rates by targeting social vulnerability in communities, such as improving access to mental health services by opening more clinics and changing the availability of insurance coverage and cost for these services. Social isolation is another factor that contributes to vulnerability, and community programs, shared public spaces, and volunteer services could build stronger social networks. Increasing access to quality health care in general would also make a difference, particularly in rural areas by expanding Medicaid coverage and increasing the number of health care workers in underserved areas. It's a laundry list of solutions to address a host of social and health disparities, given enough support.
“All of these are major factors in the social vulnerability metric, and we can improve that by improving the quality and access to mental and general physical health care,” Gibbons said. “These are malleable social features. We don’t have to wait for a social revolution to invoke change.”
The study, “Social Vulnerability and Risk of Suicide in US Adults, 2016-2020,” was published in JAMA Network Open. Additional authors include Natalie M. Bourand, Isabella L. DeClue Gustavo E. Delgado, Jiahe Fan, Sabrina K. Foster, Maaz S. Imam, Coulter B. Johnston, Franklin B. Joseph, Yihao Lu, Ujjwal Sehrawat, Li Chun Su, Ketaki Tavan, Kelly L. Zhang, Xingruo Zhang, and Loren Saulsberry from UChicago.
JOURNAL
JAMA Network Open
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Social Vulnerability and Risk of Suicide in US Adults, 2016-2020
ARTICLE PUBLICATION DATE
26-Apr-2023
Democrats, urban dwellers, and 30-40-year-olds more likely to purchase first firearms during the pandemic
Mason researchers shed new light on the changing demographic of firearm purchasers in response to the pandemic and highlight the need for more effective interventions to reduce firearm-related violence, morbidity, and mortality
Peer-Reviewed PublicationFirearm sales increased to approximately 2.5 million in March 2020, an estimated 85% increase compared to March 2019. Firearm-related injuries and deaths also increased during the pandemic. What drove people to purchase firearms (whether a previous firearm owner or not) in response to the pandemic had not been previously studied at the time of the research.
A new survey conducted across the United States led by Professor in George Mason University’s College of Public Health Amira Roess and faculty in the Department of Psychology, Leah Adams and Keith Renshaw, and student investigator Laura Henderson, shed new light on the changing demographic of firearm purchasers in response to the pandemic. The survey found that younger individuals (ages 35-40) were more likely to report purchasing a firearm for the first time due to the pandemic, as were individuals living in urban areas. They were also more likely to be Democrats, which had not previously been reported. Prior to the pandemic, American firearm owners were more likely to be male and 65 years and older, live in a rural setting, and be Republican.
“Understanding the changing demographic of who is purchasing firearms can prepare public health, law enforcement, and other responders for a possible surge in firearm-related societal impacts,” said Roess. “Our findings suggest that health education interventions that promote secure firearm storage are needed for new firearm owners and for firearm owners who live with children and others. This is a critical need especially given the reality that the United States does not have policies, nor will likely have any in the near future, to effectively reduce firearm-related violence, morbidity, and mortality.”
The survey found that Americans who purchased firearms during the pandemic, regardless of prior ownership, were more likely to report stockpiling behavior. Additionally, the survey found that keeping children at home and staying home in response to the pandemic were associated with pandemic firearm purchasing among both prior owners and new owners. The authors note that this is concerning because having children and firearms present in the same household has previously been linked to a significantly greater risk of firearm-related death.
Researchers surveyed 3,853 online participants between December 2020 and January 2021. Quotas were set to match the U.S. Census Bureau’s Voting and Registration Supplement to the Current Population Survey parameters for age, gender, race, educational attainment, census region, and Hispanic ethnicity. With the results, researchers compared demographic, pandemic-related behaviors, emotional response to COVID-19, and other determinants of those who purchased firearms in response to the pandemic with those who did not.
Predictors of firearm purchasing during the coronavirus pandemic in the United States: A cross-sectional study was published online in Elsevier Public Health Emergency Collection in April 2023.
JOURNAL
Public Health
METHOD OF RESEARCH
Survey
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Predictors of firearm purchasing during the coronavirus pandemic in the United States: A cross-sectional study
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