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Abstract
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In March 2020, as the coronavirus pandemic spread throughout the United States, Americans bought nearly 2 million guns -- the second highest monthly total in the decades since such records have been kept. Previous spikes in U.S. firearm sales have followed widely publicized mass shootings and the attendant national calls for regulations regarding the prevention of gun violence. (January 2013, the month after the massacre at Sandy Hook Elementary School in Newtown, Connecticut, holds the record for the highest number.)1 That so many Americans started or added to their personal arsenal when faced with deeply uncertain times suggests the extent to which many consider a firearm to be a form of personal protective equipment during a national emergency.
Gun violence in America is often mired in intense political or legal debate, but the special article in this issue of the Journal by Studdert and colleagues,2 which examines the relationship between handgun ownership and suicide in California, serves as yet another reminder that gun violence is unequivocally a public health issue. Two particularly important findings emerge from this rigorously conducted study: first, new handgun ownership is strongly associated with suicide immediately following California's 10-day waiting period between purchase and acquisition of a firearm; second, although the absolute risk of suicide is higher among men than among women, new handgun ownership is associated with a disproportionately greater increase in death by suicide among women.
The investigators identified handgun acquisitions among California residents on the state's voter rolls, developing a cohort of more than 26 million people who had no record of handgun ownership. Over an average of 6.9 years of follow-up, 2.6% of the cohort obtained at least one new handgun; approximately 18,000 suicides were observed, with nearly 40% completed with firearms. The finding of an association between firearm ownership and death by suicide is not surprising. Analyses conducted over decades have shown that access to a firearm is an independent risk factor for death by suicide, driven by the lethality of attempts with guns.3,4 However, this study is by far the largest, and to our knowledge the first, to focus on new firearm owners and to map the time from acquisition, allowing for one of the most granular examinations to date.
Among the new findings reported in this study is the sharp increase in death by suicide with a firearm immediately after a handgun has been acquired following a mandatory 10-day waiting period -- that is, 11 to 30 days after the purchase of the gun (hazard ratio, 100.1; 95% confidence interval [CI], 55.8 to 179.9). The fact that the risk of death from suicide is 100 times as high in the 20 days after a handgun has been acquired as before acquisition of the handgun suggests that the gun was acquired with deadly intent. A second major finding relates to handgun ownership and risk of suicide according to gender. Women who were new handgun owners were more likely to die by suicide with a firearm than women who did not own a gun...
Language: en |