Firearm Homicides and Suicides in Major …

Discussion

During 2018–2019, homicide was the sixteenth leading cause of death overall in the United States and the third leading cause among youths (2); firearm injuries were the underlying cause of death in 75% of all homicides and in 91% of youth homicides (1). From 2015–2016 to 2018–2019, firearm homicide rates among persons of all ages were nearly unchanged nationally and for the 50 largest MSAs combined. The youth firearm homicide rate for the largest MSAs combined increased somewhat across the two periods, with the national rate among youths increasing more notably; these increases coincided with those in youth firearm homicide rates for less populous metropolitan and nonmetropolitan areas which markedly exceeded the increase for the largest MSAs (3). For the largest MSAs collectively, firearm homicide rates among persons of all ages and among youths have both remained higher than corresponding national rates.

For the same period, suicide was the tenth leading cause of death nationwide among persons aged ≥10 years and the second leading cause among youths (2); firearm injuries were listed as the underlying cause of death in 50% of all suicides and in 43% of all youth suicides (1). Previously observed increases in overall firearm suicide rates continued in recent years, in the largest MSAs collectively and nationally. Youth firearm suicide rates also increased nationally but remained nearly level in the largest MSAs combined; this coincided with increases in youth rates for less populous metropolitan and nonmetropolitan areas, with the rate for nonmetropolitan areas increasing most notably (3). In contrast to firearm homicide rates, overall firearm suicide rates and youth firearm suicide rates in the largest MSAs collectively have remained lower than the corresponding national rates.

Firearm homicide remains a persistent problem in metropolitan areas in the Unites States, especially among young Black males, and increasingly, in less populous and nonmetropolitan areas as well. Previous research has found that wealth inequality, lack of trust in institutions, and economic deprivation are associated with firearm homicide rates at the county level (4). Persistently high rates among racial and ethnic minority youths might be rooted in stressors associated with living in under-resourced communities and ultimately caused by systemic racism or multigenerational poverty resulting from limited educational and economic opportunities (5). Although not specifically evaluated for effects on firearm homicide, prevention efforts that strengthen household financial security (e.g., tax credits, child care subsidies, temporary assistance to families, and livable wages) and that improve access to high-quality early childhood education have demonstrated positive effects on important risk factors for firearm homicide, including poverty, school performance, school dropout rates, substance use, behavioral problems, and arrests for violent and nonviolent offenses (6,7).

Firearm suicide similarly remains a persistent public health problem, particularly among White males. Multiple factors influence suicide risk, including family and relationship problems, job and financial concerns, mental illness, substance use, and stigma around help-seeking (8,9). The effects of the evolving drug overdose epidemic might also be contributing to the risk among youths, either directly through their own substance use or indirectly through adult use that increases the prevalence of adverse childhood experiences (6).

Another factor likely affecting both firearm homicide and suicide is access to firearms by persons at risk for harming themselves or others (10). However, the specific nature of and avenues to firearm access among inner-city youths should be more fully explored. Reducing access to lethal means before or during an acute suicidal crisis by safely storing firearms or temporarily removing them from the home can help reduce suicide risk, particularly among youths (9).

A focus on upstream prevention can potentially reduce both firearm homicide and suicide rates. This includes approaches that prevent the risk of firearm homicide and suicide in the first place, such as strengthening economic supports, strengthening access to and delivery of care, teaching coping and problem-solving skills, building positive and nurturing relationships, connecting youths to caring adults and activities, and implementing place-based interventions (e.g., remediating abandoned buildings and blighted areas, creating and maintaining green spaces, and investing in basic services and commercial activities) (6,7,9). Together, such measures are associated with reductions in youth violence and crime, suicide, and risk factors such as weapon carrying, substance use, school dropout, involvement in high-risk social networks such as gangs, depression, stress and anxiety, and suicidal thoughts and behavior (7,9). As part of a comprehensive prevention approach, individual persons and communities at increased risk should be supported through identification of and response to warning signs, through evidence-based programs and treatment (6,9), and by lessening harms after violence and suicide have occurred (6,7,9).

The findings in this report are subject to at least two limitations. First, although the findings incorporate the most recent comprehensive mortality data available at the time of analysis, they do not fully characterize changing patterns in firearm-related violence; summary statistics for 2020 indicate a further increase in the rate of firearm-related death overall, largely because of an increase in the homicide rate (3). Second, and notwithstanding the intended focus on youth firearm homicide and suicide, a broader analysis might have addressed these outcomes for other age groups not separately considered.

Firearm injuries contribute substantially to premature death and disability. Ongoing monitoring of such injuries in both metropolitan and nonmetropolitan areas can help assess and guide prevention efforts.