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Abstract
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The US stands out among developed countries for its high rates of firearm injury and related morbidity and mortality. Even though there is no comprehensive national resource that documents firearm-related injuries in real time, available data provide some insight into the epidemiology of firearm injury. This Viewpoint summarizes current data on firearm injuries in the US, discusses the limitations of available data sources, and proposes measures for a comprehensive system to track firearm injury and death.
Epidemiology
According to data from the Centers for Disease Control and Prevention (CDC), firearm injury caused 45 222 deaths in 2020 in the US, including 19 384 homicides (42.9%) and 24 292 suicides (53.7%), and was the leading cause of death among children and adolescents aged 1 through 19 years.1 Firearm homicide rates began to rise in 2015 and reached a rate of 6.1 per 100 000 in 2020. Men and boys are at approximately 10-fold higher risk of both homicide and suicide compared with women and girls. In 2020, the homicide rate for Black men and boys aged 15 to 34 years was 110.9 per 100 000 (7400 total deaths) compared with 5.2 per 100 000 (1296 total deaths) for White men and boys of the same age. Firearm suicide rates have been increasing for more than a decade and reached a rate of 8.1 per 100 000 in 2020. Firearm suicide is most common in rural areas, with rates of 11.0 per 100 000 in 2020 (8364 total deaths), and White men older than 65 years have the highest incidence of firearm suicides, with 29.0 per 100 000 in 2020 (5567 total deaths).1
Data from the national Healthcare Cost and Utilization Project suggest that there are approximately twice as many survivors of firearm injuries as there are deaths.2 From 2009 through 2017, there were approximately 85 694 emergency department (ED) visits for firearm-related injuries each year, of which 40.5% were coded as assaults, 51.0% as unintentional injuries, and 2.9% as self-harm.2 Unintentional injuries thus accounted for 1% of deaths, but 37% of total injuries, leaving major opportunities for prevention.2
Although mass shootings account for less than 1% of homicides in the US, their effect on public consciousness is outsized. Mass shootings are generally defined to involve 4 or more deaths, but varying definitions led different agencies to count between 8 and 525 mass shootings in 2022 (from January through August). Lower counts exclude shootings related to domestic violence or other crime, events that most often affect Black and Latinx individuals in the same urban, underresourced communities where firearm violence is most prevalent. The incidence of these community mass shootings has remained stable, whereas the number of high-profile public, active-shooter events has increased (such as recent mass shootings in Highland Park, Illinois, Uvalde, Texas, and Buffalo, New York).3
Law enforcement shootings of civilians also merit public concern, although these account for less than 1% of firearm deaths, and 1.6% of nonfatal injuries.2 Death rates are higher among Black individuals (1.49 mean quarterly rate per million, 2015-2020) and Native American individuals (1.74 mean quarterly rate per million, 2015-2020), than among White individuals (0.57 per mean quarterly rate per million, 2015-2020).4 Beyond loss of life, these killings have adverse effects on mental health and contribute to institutional mistrust in affected communities...
Language: en |