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Abstract
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Firearm injury mortality is a leading cause of death in the United States, and recent trends show its burden worsening.1 This burden is not distributed equally, and recent increases in firearm mortality rates are most pronounced among the demographic groups and regions that were already among the most affected.1 Descriptive epidemiology that sharpens our understanding of how firearm mortality is evolving is a critical prerequisite to identifying and addressing this worsening public problem and the accompanying health disparities.
In their recent descriptive epidemiology study, Rees at al2 further honed that understanding in their analysis of firearm mortality trends from 1990 to 2021, and how these trends break down by demographics (including within age, sex, race, and ethnicity combinations), intent (homicide, suicide, unintentional), urbanicity, and region. This fine-grained analysis2 confirmed much of what we already know about firearm injury epidemiology: the urban-rural divide, in which firearm homicides were concentrated in urban regions while suicides were concentrated in rural regions; sex differences, in which males had 7 to 17 times higher rates of firearm mortality than females, depending on mechanism; and racial disparities, in which older White men had higher rates of firearm suicide whereas the disproportionate burden of firearm homicides occurred among younger Black men. At the same time, Rees at al2 added novel insights into heterogeneity in intent-specific trajectories over the last 3 decades and underlined new and concerning trends, such as increasing suicide rates among females. The study by Rees et al2 also succinctly displayed the regional diffusion over time to show, for example, increasing concentration of firearm homicides in the Southeast US.
The findings reported by Rees and colleagues2 underscore the need to discuss and address health disparities in firearm violence. At the heart of the unequal distribution of firearm fatalities is a history of structural inequalities in the US, most notably structural racism and discrimination. Residential segregation and community divestment disproportionately affect minoritized racial and ethnic groups (such as Black and American Indian or Alaska Native individuals), minoritized gender identities, and other people with marginalized identities. Not only does the empirical evidence show that these factors are linked to higher stress responses, anxiety, and depression,3 but they are also related to higher levels of violence—particularly firearm violence. But racial disparities do not exist in a vacuum, and it is increasingly important to recognize how multiple social identities intersect (eg, ethnicity, class, gender, sexuality, and skin tone) to create unique challenges for different subgroups. For example, the specific racism experienced by Asian individuals during the COVID-19 pandemic is associated with mental distress and firearm purchase and carriage,4 placing Asian individuals at an elevated risk of firearm injury and mortality more recently.
Language: en |