Bixby Center Lecture on "Firearms and violent death in the United States"

1. Firearms and violent death in
the
United States
Deborah Azrael
Harvard Injury Control Research Center
Harvard School of Public Health
CHS 296: Violence, Health and Prevention, UCLA
January 26, 2016

2. Outline
• Overview of firearm deaths in the US
• International comparisons
• Homicide
• Suicide
• Gun ownership in the US
• Special topics:
• Children
• Mass shootings
• Law Enforcement shootings of civilians
• Public health approach to reducing gun violence
• Take homes

3. • Almost as many Americans died from gunfire (33,599) as died from motor vehicle
crashes (35,657), or unintentional drug poisoning (38,718)
CDC WONDER: http://wonder.cdc.gov/mortSQL.html,
10,945
21,334
586 494
Firearm Homicide
Firearm Suicide
Firearm Accidents
Legal Intervention
Deaths (firearm)
Understanding the Problem: Firearm
Deaths in the US, 2014

4. International Comparisons

5. Percentage of People Victimized in 2000
(from comparable victimization surveys)
Nation Car Theft Burglary Robbery Sexual
Incident
Assault or
Threat
United States 0.5 1.8 0.6 1.5 3.4
17
Industrialized
Nations*
1.0 1.8 0.8 1.7 3.5
*Australia, Belgium, Canada, Catalonia (Spain), Denmark, England & Wales, Finland, France,
Japan, Netherlands, Northern Ireland, Poland, Portugal, Scotland, Sweden, Switzerland, USA
**Additional crimes: theft from car, car vandalism, motorcycle theft, bike theft, attempted
burglary, personal theft
Source: Van Kesteren et al. 2000
11
Crimes**
21.1
21.3

6. Firearm and Non-Firearm Homicide Rates per/100k
Nation Firearm
Homicide
Rate
Non-Firearm
Homicide
Rate
Total
Homicide
Rate
Percentage
of
Households
with Guns
United States 3.1 1.5 4.6 35%
United
Kingdom
0.1 1.3 1.4 7%
Canada 0.6 1.2 1.8 24%
Australia 0.1 1.3 1.4 15%
New Zealand 0.2 0.9 1.1 23%
Sources: UK: UCR 2009, norc.org (2006)
UK: UNODC 2008; Small Arms Survey 2007
Canada: Beattie 2009, Royal Canadian mounted Police 2010
Australia: AU Bureau of Statistics 2009; Small Arms Survey 2007
New Zealand: UNODC 2008; Small Arms survey 2007

7. Homicide, Suicide, and Unintentional Gun Deaths among 5-14 year olds:
United States vs. 22 Other High Income Populous Countries, 2010
Source: Grinshteyn & Hemenway AJM, 2015
• US =34% of the total population (of all 23 countries combined) but 91% of all children killed by
firearms were US children
• There is no evidence that our children are more careless or more depressed or more violent.
Mortality Rate Ratio
Homicides
Gun Homicides 18.5
Non-gun homicides 1.4
Total 3.4
Suicides
Gun Suicides 11.2
Non-gun suicides 1.1
Total 1.5
Unintentional firearm deaths 12.2
TOTAL FIREARM DEATHS 14.2

8. U.S. Ecological Studies
U.S. Case Control Studies
• Where there are more guns, more people die by homicide – because
there are more gun homicides
• Women
• Men
• Children
• Police officers
• Civilians by police officers
• Where there are more guns, more people die by suicide – because there
are more gun suicides
• Where there are more guns, there are more unintentional firearm deaths

9. Gun ownership estimates
• GSS 1972-2014 provides information, by 9 Census
regions, of % of respondents who report
• Do you happen to have any guns in your home or garage?
• If yes, Do you personally own a gun?
• BRFSS 2001, 2002, 2004 (but not since) provides state
level information on % of respondents who report:
• Do you or does someone you live with own a firearm
• In the absence of routinely collected data on gun
ownership, researchers (Cook; Azrael, Cook & Miller;
others), establish FS/S as high quality proxy for
household firearm ownership.

10. US Homicide Rate: 1979-2014

11. Homicide

12. 0
10203040
2000 2005 2010 2015
Year
THBM FHBM
NFHBM THWM
FHWM NFHWM
Homicide Rates: US Males (1999-2014)
Source: Web-based Injury Statistics and Reporting System
(WISQARS), CDC National Center for Injury Prevention and Control

13. Homicide Rates: US Males 15-29 (1999-
2014)
0
20406080
100
2000 2005 2010 2015
Year
THWM FHWM
NFHWM THBM
FHBM NFHBM
Source: Web-based Injury Statistics and Reporting System (WISQARS), CDC
National Center for Injury Prevention and Control

14. Homicide 2014
Firearm Non-firearm
Male Female Male Female
White 3310 (.21) 1041 (.07) 1965 (.12) 1046 (.07)
Black 5686 (.36) 611 (.04) 1112 (.07) 467 (.03)
Other 227 (.01) 70 (<.01) 191 (.01) 83 (.01)

15. Firearm Non-firearm
N
Occurred in
a house/apt
Occurred
at victim's
residence N
Occurred
in a
house/apt
Occurred
at victim's
residence
Homicides by Age Group
0-4 yrs 81 75% 67% 1,025 90% 77%
5-14 yrs 257 72% 51% 205 78% 67%
15-24 yrs 5,679 37% 16% 1,385 47% 27%
25-34 yrs 4,906 44% 24% 1,479 56% 39%
35-64 yrs 5,003 56% 41% 3,716 62% 50%
65+ yrs 470 74% 69% 719 79% 76%
Suicides by Age Group
0-4 yrs -- --
5-14 yrs 105 97% 88% 301 91% 88%
15-24 yrs 3,332 75% 64% 3,769 69% 65%
25-34 yrs 4,034 76% 67% 4,743 70% 65%
35-64 yrs 15,634 78% 74% 16,568 72% 70%
65+ yrs 6,019 89% 88% 2,168 80% 83%
*Unknowns for age (0.7%), house-apt (1.4%), home (3.6%) were set aside.
NVDRS 2005-2010
Miller M, Azrael D, Hemenway D. Firearms and Violent Death in the United States. In Reducing Gun Violence in
America: Informing Policy with Evidence and Analysis. Johns Hopkins University Press. 2715 North Charles Street,
Baltimore, MD. 2013.

16. HOMICIDE High-Gun States Low-Gun States Ratio
Women
Firearm Homicide 3165 998 3.2
Non-Firearm Homicide 2855 2132 1.3
Total Homicide 6020 3130 1.9
5-14 year olds
Firearm Homicide 259 100 2.6
Non-Firearm Homicide 212 169 1.3
Total Homicide 471 269 1.8
Adults 65+
Firearm Homicide 620 139 4.5
Non-Firearm Homicide 794 534 1.5
Total Homicide 1414 673 2.1
Men 15-29
Firearm Homicide 6971 4900 1.4
Non-Firearm Homicide 1187 1334 0.9
Total Homicide 8158 6234 1.3
Miller M, Azrael D, Hemenway D. Firearms and Violent Death in the United States. In Reducing Gun Violence in
America: Informing Policy with Evidence and Analysis. Johns Hopkins University Press.

17. Suicide and Guns

18. U.S. Suicide Deaths (rate/100,000)
0
2
4
6
8
10
12
14 1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
rate/100,000
(Age-adjusted rates)
The suicide rate dropped about 16.5%
comparing 1985 with 2000. In recent
years, however, most the ground has
been lost.

19. U.S. Suicide Rate, by Method
0
1
2
3
4
5
6
7
8
9
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
rate/100,000
Firearm
Poison
Suffocation
Other

20. U.S. Suicide Rate, by Method
0
1
2
3
4
5
6
7
8
9
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
rate/100,000
Firearm
Poison
Suffocation
Other
Firearms
The decline
in the suicide
rate in the
1990s was
largely due to
a decline in
firearm
suicides.

21. Suicide Rates by State-level Gun Ownership
Source: BRFSS 2001, NCHS; chart in http://www.armedwithreason.com/suicides-the-missing-movement/

22. Changes in Household Firearm Ownership
and Suicide Rates: 1980-2005
Source: Miller, Azrael, Hemenway et al. Injury Prevention, 2006

23. • Case-control studies have controlled for measures of
psychopathology
• People who live in homes with guns DO NOT have higher rates
of psychiatric illness, substance abuse, or other known suicide
risk factors
• The risk of suicide associated with a household firearm pertains
not only to gun owners, but to all household members
 the relative risk is larger for adolescents than for the gun owner
 the risk persists for years after firearms are purchased
• Hierarchy of suicide risk among children and young adults,
depending on how securely household firearms are stored
Suicide and Guns

24. Serious Psychological Distress in Past Year, Annual Incidence Based on 2003 and
2004 NSDUH data. See http://www.oas.samhsa.gov/2k4State/ch6.htm
Suicide data from WISQARS

25. • Firearms more lethal than most other commonly used
methods
• Suicide acts are often impulsive
• Crises are often temporary
• Few survivors, even of near-lethal suicide attempts, go
on to commit suicide
Firearms and Suicide

26. Firearm Suicide: High vs. Low Gun States

27. Summary
• The United States, with many guns and highly permissive gun laws,
faces a far more serious LETHAL violence public health problem than
other developed nations
• In the United States, where guns are more available in homes and
communities many more people die, not only in criminal acts, but by
suicide and unintentional firearm injury.
• The consistency of findings across different populations, using different study designs,
and by different researchers is striking. No credible evidence suggests otherwise
• Firearm policy is often focused on guns used in crime. However, what
is notable about the studies reviewed here is the consistency of the
story they tell more generally about firearms in the home, most of
which are presumably legally acquired and possessed, and distributed
currently in one out of every three homes