Abstract
IMPORTANCE Understanding global variation in firearm mortality rates could guide prevention policies and interventions. OBJECTIVE To estimate mortality due to firearm injury deaths from 1990 to 2016 in 195 countries and territories. DESIGN, SETTING, AND PARTICIPANTS This study used deidentified aggregated data including 13 812 location-years of vital registration data to generate estimates of levels and rates of death by age-sex-year-location. The proportion of suicides in which a firearm was the lethal means was combined with an estimate of per capita gun ownership in a revised proxy measure used to evaluate the relationship between availability or access to firearms and firearm injury deaths. EXPOSURES Firearm ownership and access. MAIN OUTCOMES AND MEASURES Cause-specific deaths by age, sex, location, and year. RESULTS Worldwide, it was estimated that 251 000 (95%uncertainty interval [UI], 195 000-276 000) people died from firearm injuries in 2016, with 6 countries (Brazil, United States, Mexico, Colombia, Venezuela, and Guatemala) accounting for 50.5%(95%UI, 42.2%-54.8%) of those deaths. In 1990, there were an estimated 209 000 (95%UI, 172 000 to 235 000) deaths from firearm injuries. Globally, the majority of firearm injury deaths in 2016 were homicides (64.0% [95%UI, 54.2%-68.0%]; absolute value, 161 000 deaths [95%UI, 107 000-182 000]); additionally, 27%were firearm suicide deaths (67 500 [95%UI, 55 400-84 100]) and 9% were unintentional firearm deaths (23 000 [95%UI, 18 200-24 800]). From 1990 to 2016, there was no significant decrease in the estimated global age-standardized firearm homicide rate (-0.2%[95%UI, -0.8%to 0.2%]). Firearm suicide rates decreased globally at an annualized rate of 1.6%(95%UI, 1.1-2.0), but in 124 of 195 countries and territories included in this study, these levels were either constant or significant increases were estimated. There was an annualized decrease of 0.9% (95%UI, 0.5%-1.3%) in the global rate of age-standardized firearm deaths from 1990 to 2016. Aggregate firearm injury deaths in 2016 were highest among persons aged 20 to 24 years (for men, an estimated 34 700 deaths [95%UI, 24 900-39 700] and for women, an estimated 3580 deaths [95%UI, 2810-4210]). Estimates of the number of firearms by country were associated with higher rates of firearm suicide (P <.001; R2 = 0.21) and homicide (P <.001; R2 = 0.35). CONCLUSIONS AND RELEVANCE This study estimated between 195 000 and 276 000 firearm injury deaths globally in 2016, the majority of which were firearm homicides. Despite an overall decrease in rates of firearm injury death since 1990, there was variation among countries and across demographic subgroups.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 792-814 |
| Number of pages | 23 |
| Journal | JAMA - Journal of the American Medical Association |
| Volume | 320 |
| Issue number | 8 |
| DOIs | |
| State | Published - Aug 28 2018 |
Funding
completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Ms Ayala Quintanilla reports receipt of support to her institution (the Judith Lumley Centre of La Trobe University) from PRONABEC (the national program of scholarship and educational loan) to support current study of her doctoral course. Dr Kieling reports receipt of authorship royalties from Brazilian publishers Artmed and Manole. Dr Larson reports that her research group has a contract with GlaxoSmithKline for a 15-country study on vaccine acceptance during pregnancy and receipt of funds for convening a research symposium from Merck. Mr Matzopoulos reports serving on the board (unpaid) of Gun Free South Africa. Dr Singh reports receipt of consultancy fees from Savient, Takeda, Regeneron, Merz, Iroko, bioiberica, Crealta/Horizon, allergan, fidia, UBM LLC, WebMD, and the American College of Rheumatology; grants to his institution from Takeda and Savient; serving as the principal investigator for a study funded by Horizon Pharmaceuticals through a grant to DINORA; and serving on the steering committee of OMERACT (Outcome Measures in Rheumatology). Dr Stein reports receipt of personal fees from Lundbeck, Biocodex, Servier, and SUN outside the submitted work. No other disclosures were reported. Affiliations of The Global Burden of Disease 2016 Injury Collaborators: Institute for Health Metrics and Evaluation, University of Washington, Seattle (Naghavi, Marczak, Kutz, Shackelford, M. Arora, Miller-Petrie, Bennett, L. Dandona, R. Dandona, Dharmaratne, Feigin, Foreman, Fullman, Hawley, James, Khalil, Krohn, Larson, Salama, Hay, Lim, Lopez, Mokdad, Vos, Murray); Higher National School of Veterinary Medicine, Algiers, Algeria (Aichour); Centre for Global Child Health, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada (Akseer, Bhutta); Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Al-Raddadi); School of Population and Global Health, University of Western Australia, Perth, WA, Australia (Alam); Department of Population Health, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (Alghnam); Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines (Antonio); Department of Public and Community Health, Birmingham City University, Birmingham, England (Aremu); School of Science and Health, Western Sydney University, Penrith, NSW, Australia (A. Arora); Oral Health Services, Sydney Local Health District, Sydney, Australia (A. Arora); Department of Epidemiology and Biostatistics, Iran University of Medical Sciences, Tehran, Iran (Asadi-Lari); International Relations Department, Iranian Ministry of Health and Medical Education, Tehran, Iran (Asadi-Lari); Education Development Center, Mashhad University of Medical Sciences, Mashhad, Iran (Assadi); Department of Pharmacy, Mekelle University, Mekelle, Ethiopia (Atey); Center of Health System Research, The National Institute of Public Health, Cuernavaca, Mexico (Avila-Burgos); Indian Institute of Public Health, Gandhinagar, India (Awasthi); Public Health Foundation of India, Gurugram, India (Awasthi, L. Dandona, R. Dandona, Kumar); The Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia (Ayala Quintanilla); General Office for Research and Technological Transfer, Peruvian National Institute of Health, Lima, Peru (Ayala Quintanilla); School of Psychology, University of Auckland, Auckland, New Zealand (Barker-Collo); Institute of Public Health, Heidelberg University, Heidelberg, Germany (Bärnighausen, Mohammed); Department of Global Health and Population, Harvard University, Boston, Massachusetts (Bärnighausen); Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, California (Bazargan-Hejazi); Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles (Bazargan-Hejazi); Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorranmabad, Iran (M. Behzadifar); Faculty of Health and Nutrition, Lorestan University of Medical Sciences, Khorranmabad, Iran (M. Behzadifar); Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India (Bhalla); Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan (Bhutta); School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia (Bilal); Department of Epidemiology, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico (Borges); Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia (Borschmann); Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia (Borschmann); Institute of Epidemiology, Comenius University, Bratislava, Slovakia (Brazinova); National Institute of Health, Cuernavaca, Mexico (Campuzano Rincon); Escuela de Medicina, Universidad Valle de Cuernavaca, Cuernavaca, Mexico (Campuzano Rincon); Ucibio, Requimte, Faculty of Pharmacy, University of Porto, Porto, Portugal (Carvalho); Colombian National Health Observatory, Instituto Nacional de Salud, Bogota, Colombia (Castañeda-Orjuela); Epidemiology and Public Health Evaluation Group, Universidad Nacional de Colombia, Bogota, Colombia (Castañeda-Orjuela); Department of Clinical Toxicology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom (Dargan); Department of Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom (Dargan); Australian Institute for Suicide Research and Prevention, Griffith University, Mt Gravatt, QLD, Australia (De Leo); Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka (Dharmaratne); Harvard School of Public Health, Department of Nutrition, Harvard University, Boston, Massachusetts (Ding); Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam (Phuc Do, Tat Nguyen, Le Nguyen, Thanh Tran); Department of Population and Health, University of Cape Coast, Cape Coast, Ghana (Doku); Faculty of Social Sciences, University of Tampere, Tampere, Finland (Doku); School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University (RMIT), Bundoora, VIC, Australia (Doyle); Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia (Driscoll); School of Pharmacy, Haramaya University, Harar, Ethiopia (Edessa); Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden (El-Khatib); Department of Public Health, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia (Endries); Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran (Esteghamati); Department of Psychology, Federal University of Sergipe, Sao Cristovao, Brazil (Faro); Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran Funding/Support: This study was funded by the Bill & Melinda Gates Foundation (OPP1152504).
ASJC Scopus subject areas
- General Medicine
