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Abstract
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Degli Esposti and colleagues1 have advanced the firearm injury literature with their study of changes in county-level firearm mortality from 1989 to 2019. By pooling data across neighboring counties with bayesian spatial models, the authors generate county-level estimates of firearm mortality, even where outcomes are sparse. They use these estimates to identify counties that have deviated from national trends over the 30-year study period. Despite fairly small changes in overall firearm mortality from 1989 to 2019, the authors find important patterns. Firearm homicides have declined overall, but numerous high outliers have trailed behind this trend, including Baltimore, Maryland, and many urban counties in the Southeast US. Firearm suicides have increased overall, associated with widespread increases across rural counties, especially in the West and Midwest.1
Degli Esposti and colleagues' findings1 underscore the need to use national data to improve our understanding of localized firearm injury patterns. As the authors note, prior work has often been designed to infer the effects of state-level firearm policies, using states as the geographical unit of analysis. However, state-level policy environment is not necessarily a prime factor associated with firearm injuries: for instance, researchers have found only modest associations between state-level firearm laws and firearm injury rates in urban counties,2 where most US residents live. Studying geographical units smaller than states is necessary for understanding the community-level factors that influence risk and directing resources to the right places.
Another strength of Degli Esposti and colleagues' study1 is that it examines trends over many years, from a period (1989-1994) of particularly high firearm homicide rates, to the period (2015-2019) just before the COVID-19 pandemic, when an unprecedented spike in firearm homicides occurred. The authors' finding that US residents continued to die from firearm injuries at approximately the same rates, despite the "great crime decline" of the mid-to-late 1990s,3 is striking. Yet the authors are also able to document a repatterning of firearm mortality over that period, with a growing share of firearm deaths arising from homicide in majority-Black urban counties and from suicide in majority-White rural counties.1 These spatiotemporal trends point toward several key issues for research and practice...
Language: en |