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Firearm legislation and firearm mortality in the USA: a cross-sectional, state-level study.
Lancet 2016; 387(10030):1847-55Lct

Abstract

BACKGROUND

In an effort to reduce firearm mortality rates in the USA, US states have enacted a range of firearm laws to either strengthen or deregulate the existing main federal gun control law, the Brady Law. We set out to determine the independent association of different firearm laws with overall firearm mortality, homicide firearm mortality, and suicide firearm mortality across all US states. We also projected the potential reduction of firearm mortality if the three most strongly associated firearm laws were enacted at the federal level.

METHODS

We constructed a cross-sectional, state-level dataset from Nov 1, 2014, to May 15, 2015, using counts of firearm-related deaths in each US state for the years 2008-10 (stratified by intent [homicide and suicide]) from the US Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System, data about 25 firearm state laws implemented in 2009, and state-specific characteristics such as firearm ownership for 2013, firearm export rates, and non-firearm homicide rates for 2009, and unemployment rates for 2010. Our primary outcome measure was overall firearm-related mortality per 100,000 people in the USA in 2010. We used Poisson regression with robust variances to derive incidence rate ratios (IRRs) and 95% CIs.

FINDINGS

31,672 firearm-related deaths occurred in 2010 in the USA (10·1 per 100,000 people; mean state-specific count 631·5 [SD 629·1]). Of 25 firearm laws, nine were associated with reduced firearm mortality, nine were associated with increased firearm mortality, and seven had an inconclusive association. After adjustment for relevant covariates, the three state laws most strongly associated with reduced overall firearm mortality were universal background checks for firearm purchase (multivariable IRR 0·39 [95% CI 0·23-0·67]; p=0·001), ammunition background checks (0·18 [0·09-0·36]; p<0·0001), and identification requirement for firearms (0·16 [0·09-0·29]; p<0·0001). Projected federal-level implementation of universal background checks for firearm purchase could reduce national firearm mortality from 10·35 to 4·46 deaths per 100,000 people, background checks for ammunition purchase could reduce it to 1·99 per 100,000, and firearm identification to 1·81 per 100,000.

INTERPRETATION

Very few of the existing state-specific firearm laws are associated with reduced firearm mortality, and this evidence underscores the importance of focusing on relevant and effective firearms legislation. Implementation of universal background checks for the purchase of firearms or ammunition, and firearm identification nationally could substantially reduce firearm mortality in the USA.

FUNDING

None.

Authors+Show Affiliations

Department of Medicine, Boston University, Boston, MA, USA. Electronic address: kalesan@bu.edu.Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.Columbia Law School and Department of Epidemiology, Columbia University, New York, NY, USA.School of Public Health, Boston University, Boston, MA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26972843

Citation

Kalesan, Bindu, et al. "Firearm Legislation and Firearm Mortality in the USA: a Cross-sectional, State-level Study." Lancet (London, England), vol. 387, no. 10030, 2016, pp. 1847-55.
Kalesan B, Mobily ME, Keiser O, et al. Firearm legislation and firearm mortality in the USA: a cross-sectional, state-level study. Lancet. 2016;387(10030):1847-55.
Kalesan, B., Mobily, M. E., Keiser, O., Fagan, J. A., & Galea, S. (2016). Firearm legislation and firearm mortality in the USA: a cross-sectional, state-level study. Lancet (London, England), 387(10030), pp. 1847-55. doi:10.1016/S0140-6736(15)01026-0.
Kalesan B, et al. Firearm Legislation and Firearm Mortality in the USA: a Cross-sectional, State-level Study. Lancet. 2016 Apr 30;387(10030):1847-55. PubMed PMID: 26972843.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Firearm legislation and firearm mortality in the USA: a cross-sectional, state-level study. AU - Kalesan,Bindu, AU - Mobily,Matthew E, AU - Keiser,Olivia, AU - Fagan,Jeffrey A, AU - Galea,Sandro, Y1 - 2016/03/11/ PY - 2016/3/15/entrez PY - 2016/3/15/pubmed PY - 2016/6/2/medline SP - 1847 EP - 55 JF - Lancet (London, England) JO - Lancet VL - 387 IS - 10030 N2 - BACKGROUND: In an effort to reduce firearm mortality rates in the USA, US states have enacted a range of firearm laws to either strengthen or deregulate the existing main federal gun control law, the Brady Law. We set out to determine the independent association of different firearm laws with overall firearm mortality, homicide firearm mortality, and suicide firearm mortality across all US states. We also projected the potential reduction of firearm mortality if the three most strongly associated firearm laws were enacted at the federal level. METHODS: We constructed a cross-sectional, state-level dataset from Nov 1, 2014, to May 15, 2015, using counts of firearm-related deaths in each US state for the years 2008-10 (stratified by intent [homicide and suicide]) from the US Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System, data about 25 firearm state laws implemented in 2009, and state-specific characteristics such as firearm ownership for 2013, firearm export rates, and non-firearm homicide rates for 2009, and unemployment rates for 2010. Our primary outcome measure was overall firearm-related mortality per 100,000 people in the USA in 2010. We used Poisson regression with robust variances to derive incidence rate ratios (IRRs) and 95% CIs. FINDINGS: 31,672 firearm-related deaths occurred in 2010 in the USA (10·1 per 100,000 people; mean state-specific count 631·5 [SD 629·1]). Of 25 firearm laws, nine were associated with reduced firearm mortality, nine were associated with increased firearm mortality, and seven had an inconclusive association. After adjustment for relevant covariates, the three state laws most strongly associated with reduced overall firearm mortality were universal background checks for firearm purchase (multivariable IRR 0·39 [95% CI 0·23-0·67]; p=0·001), ammunition background checks (0·18 [0·09-0·36]; p<0·0001), and identification requirement for firearms (0·16 [0·09-0·29]; p<0·0001). Projected federal-level implementation of universal background checks for firearm purchase could reduce national firearm mortality from 10·35 to 4·46 deaths per 100,000 people, background checks for ammunition purchase could reduce it to 1·99 per 100,000, and firearm identification to 1·81 per 100,000. INTERPRETATION: Very few of the existing state-specific firearm laws are associated with reduced firearm mortality, and this evidence underscores the importance of focusing on relevant and effective firearms legislation. Implementation of universal background checks for the purchase of firearms or ammunition, and firearm identification nationally could substantially reduce firearm mortality in the USA. FUNDING: None. SN - 1474-547X UR - https://www.unboundmedicine.com/medline/citation/26972843/Firearm_legislation_and_firearm_mortality_in_the_USA:_a_cross_sectional_state_level_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(15)01026-0 DB - PRIME DP - Unbound Medicine ER -