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Epidemiologic Trends in Fatal and Nonfatal Firearm Injuries in the US, 2009-2017
JAMA Intern Med. Published online December 7, 2020. doi:10.1001/jamainternmed.2020.6696
JAMA Intern Med. Published online December 7, 2020. doi:10.1001/jamainternmed.2020.6696
From 2009 to 2017, there was an annual average of 85 694 emergency department visits for nonfatal firearm injury and 34 538 deaths from firearm injury.
Although suicide accounted for 61% of deaths, self-harm accounted for only 3% of nonfatal injuries; assaults accounted for 35% of deaths and 41% of nonfatal injuries, and unintentional injuries accounted for 2% of deaths and 51% of nonfatal injuries
Firearm injury is a major public health challenge in the US
Self-harm injuries caused 21 128 deaths (61.2%) and 2501 nonfatal injuries (2.9%) per year. The case fatality rate was 89.4% (95% CI, 88.5%-90.4%), which was the highest of any intent, with no significant change over time
Rates of self-harm injury and death were higher in rural areas (11.2 per 100 000 people per year) than in urban areas (6.3 per 100 000) and were highest in people aged 55 years or older (11.3 per 100 000).
Rates of death from self-harm increased from 6.1 to 7.3 per 100 000 per year from 2009 to 2017 (P = .004 for trend) with no significant change in the rate of nonfatal injuries
Rates of unintentional injury were higher in rural than in urban areas (18.5 per 100 000 vs 12.4 per 100 000), and the highest rates were among people aged 15 to 34 years
Unintentional injuries were the most common type among children younger than 15 years, with an incidence of 11.3 per 100 000 per year.
For every person who died from a firearm injury, there were another 2 people who survived, but rates and likelihood of survival varied widely by intent.
Deaths due to self-harm increased in urban and rural areas and for all age groups, consistent with prior evidence. Suicide, a form of “death of despair,” has increased in incidence among people with limited resources in the US as they age and as access to firearms has grown.
Individuals who attempt suicide with a firearm are more likely to die than those who use any other means.
Therefore, access to firearms increases the risk of completed suicide, reducing the opportunity for mental health treatment
Therefore, access to firearms increases the risk of completed suicide, reducing the opportunity for mental health treatment
Suicide appears to be the most common cause of firearm injury death in the US, and most people who die from suicide never reach the hospital. Assault and unintentional injuries account for most nonfatal and overall firearm injuries.
Comprehensive data including nonfatal injuries are needed to develop effective public health strategies for prevention and treatment.
