Firearm injuries and death: A United States epidemic with public health solutions

Abstract

Firearm injuries and death are an eminently preventable public health epidemic in the United States (U.S.).Globally, for the last several decades, U.S. firearm homicide rates far outpaced those of other high-income countries, with more than 45,000 people killed by firearms in the U.S. in 2020 alone-greater than in any previous year on record [1,2].U.S. children are 11 times more likely to die of a firearm injury than children in other high-income countries [3], and firearm injury is the leading cause of death for Americans age 1-19 (largely due to homicide) [4].This epidemic also has a disproportionate impact on people who are Black, Indigenous and/or people of color (BIPOC), especially in socially vulnerable, underserved communities.Firearm homicide is the leading cause of death for Black males 15-34 years old, and Black men are 10-20 times more likely to be killed by a gun than White men [1].American Indian and Alaskan Native men are 3-4 times more likely to die by firearm suicide than White men [2].Despite the growing frequency of school shootings and public mass shootings in the U.S, mass shootings in schools and other public spaces make up a minority of U.S. firearm injuries and deaths [1].Instead, most U.S. firearm deaths are homicide and suicide.Indeed, firearms are the most common mechanism by which U.S. adults and children die from suicide, with approximately 53% of suicide deaths resulting from firearms in 2021 [1].Firearms are also the most common mechanism of homicide, causing 80% of U.S. homicide deaths in 2021 [1].Intimate partner homicide is most frequently completed with firearms in the U.S. [2].Most nonfatal firearm injuries are due to assault [1].The impact of these violent injuries on individuals, families, communities and U.S. society is massive [5], ranging from anxiety, to substance use, to increased firearm purchasing.Studies suggest a strong, but not complete, correlation between rates of firearm ownership and number of firearm deaths [6].Other causes of injury and death are also at play.For example, underinvestment in the physical structure of a city has been shown to influence rates of firearm ownership and death.Firearm ownership practices related to beliefs around the need for selfprotection may contribute to unintentional injury rates.A history of firearm trauma-and resultant patterns of post-traumatic stress, substance use, involvement in the criminal justice system, and carrying firearms for self-protection-may lead to perpetuating cycles of firearm injury and death [7].Structural racism, which includes residential segregation, low-quality schools, limited healthcare resources, and lack of implementation of effective criminal justice policy, further contributes to adverse social determinants of health that increase risk for firearm assault [8].

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