Firearm Fatalities Research Articles

Firearm mortality in California, 2000–2015: the epidemiologic importance of within-state variation

PurposeFirearm mortality is a significant problem in the United States. Previous studies have largely focused on firearm mortality at the national or state level, leaving open the question of within-state variation. This study examined firearm mortality within California. MethodsWe used Multiple Cause of Death data files to identify all firearm fatalities in California from 2000 to 2015. We described firearm mortality rates and counts over time, by age and county, stratifying by intent, gender, and race/ethnicity. County-level rates were smoothed with empirical Bayes estimates from random-effect Poisson models. ResultsFrom 2000 to 2015, there were 24,922 firearm homicides and 23,682 firearm suicides in California. Rates of firearm homicide decreased 30% and suicide rates increased 1% since the mid-2000s, but these trends varied substantially by county. Due to a decline in firearm homicides in metropolitan areas, there was no significant difference in these rates between urban and rural counties by 2015. Non-Hispanic black men had the highest rate of firearm homicide, but Hispanic men had the greatest number of deaths. ConclusionsWe found considerable intrastate variation in firearm mortality in California. Our results will be of interest to researchers, policymakers, and public health practitioners. Similar epidemiologic profiles of firearm mortality are warranted for other states.

Firearm Violence across the Lifespan: Relevance and Theoretical Impact on Child and Adolescent Educational Prospects

Firearm violence in United States has been a persistent concern for decades particularly in light of mass shootings. Firearm violence is increasingly viewed as a public health crisis, and results in a heavy financial burden to society. In light of the continuous challenges associated with firearm violence, limited research in the area, it is necessary to examine current trends regarding firearm deaths and injuries. Extant data from the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Web-based Inquiry Statistics Query and Reporting System fatal and nonfatal injury reports were used for this study. Available data were examined in light of age groups across the life span, region, gender, and minority status for both fatalities and injuries related to firearms. Strategies for reducing firearm fatalities, particularly among children and youth, are also discussed.

Has Texas Experienced an Epidemic of Firearms-Related Deaths?

In-depth examination of complete datasets from the FBI and Centers for Disease Control indicates that Texas has become safer over time: • When comparing Texas data and national trends, Texans have become safer. • While some data shows an increase in the number of certain firearms fatalities, after including Texas’s exceptional population growth during the same time period, Texas still experienced significant declines in firearms fatality rates. • Suicides now account for nearly two-thirds of all firearms fatalities. • Non-firearms suicides have increased at an exceptional rate, a trend reflected in national data. Despite this trend, firearms-involved suicide rates declined faster in Texas.

Suicide, guns, and buyback programs: An epidemiologic analysis of firearm-related deaths in Connecticut.

Gun buyback programs aim to remove unwanted firearms from the community with the goal of preventing firearm injury and death. Buyback programs are held in many communities, but evidence demonstrating their effectiveness is lacking. The purpose of this study is to compare firearms collected at buyback events to crime guns and firearms used in homicides and suicides. Detailed firearm and case data were obtained from the Hartford Police Department and the Office of the Chief Medical Examiner from January through December of 2015. Information was reviewed for guns collected at buyback events, crime guns confiscated by police, and for weapons associated with firearm fatalities. Detailed firearm data included type, manufacturer, model, and caliber (small, ≤ 0.32 caliber; medium, 0.357 caliber to 9 mm; large, ≥ 0.40 caliber). χ analyses were used for comparisons between groups. In 2015, 224 crime guns were seized by the Hartford Police, 169 guns were collected at four community buyback events, and there were 187 firearm-related deaths statewide (105 suicides, 81 homicides, 1 legal intervention). Comparisons between buyback, crime, and fatality-related firearms are shown in the table below. Medium caliber handguns account for the majority of crime guns and fatalities, and buyback programs collected smaller caliber handguns. The demographics of individuals who turn in guns at buyback events and commit suicide are similar: age (buyback, 63 ± 11; suicide, 52 ± 18; homicide, 34 ± 12 years), sex (buyback, 81%; suicide, 91%; homicide, 84% men), and race (buyback, 80%; suicide, 97%; homicide, 47% white). Handguns account for the majority of crime guns and firearm-related fatalities in Connecticut. Buyback programs are both an opportunity to remove unwanted handguns from the community and to remove firearms from the homes of individuals at increased risk of suicide. Epidemiologic/therapeutic study, level IV.

Childhood Firearm Injuries in the United States.

Examine fatal and nonfatal firearm injuries among children aged 0 to 17 in the United States, including intent, demographic characteristics, trends, state-level patterns, and circumstances. Fatal injuries were examined by using data from the National Vital Statistics System and nonfatal injuries by using data from the National Electronic Injury Surveillance System. Trends from 2002 to 2014 were tested using joinpoint regression analyses. Incident characteristics and circumstances were examined by using data from the National Violent Death Reporting System. Nearly 1300 children die and 5790 are treated for gunshot wounds each year. Boys, older children, and minorities are disproportionately affected. Although unintentional firearm deaths among children declined from 2002 to 2014 and firearm homicides declined from 2007 to 2014, firearm suicides decreased between 2002 and 2007 and then showed a significant upward trend from 2007 to 2014. Rates of firearm homicide among children are higher in many Southern states and parts of the Midwest relative to other parts of the country. Firearm suicides are more dispersed across the United States with some of the highest rates occurring in Western states. Firearm homicides of younger children often occurred in multivictim events and involved intimate partner or family conflict; older children more often died in the context of crime and violence. Firearm suicides were often precipitated by situational and relationship problems. The shooter playing with a gun was the most common circumstance surrounding unintentional firearm deaths of both younger and older children. Firearm injuries are an important public health problem, contributing substantially to premature death and disability of children. Understanding their nature and impact is a first step toward prevention.

The Hidden Epidemic of Firearm Injury: Increasing Firearm Injury Rates During 2001-2013.

Investigating firearm injury trends over the past decade, we examined temporal trends overall and according to race/ethnicity and intent in fatal and nonfatal firearm injuries (FFIs and NFIs) in United States during 2001-2013. Counts of FFIs and estimated counts of NFIs were obtained from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System. Poisson regression was used to analyze overall and subgroup temporal trends and to estimate annual change per 100,000 persons (change). Total firearm injuries (n = 1,328,109) increased annually by 0.36 (Ptrend<0.0001). FFIs remained constant (change=0.02; Ptrend=0.22) while NFIs increased (change=0.35; Ptrend<0.0001). Homicide FFIs declined (change=-0.05; Ptrend<0.0001) while homicide NFIs increased (change=0.43; Ptrend<0.0001). Suicide FFIs increased (change=0.07; Ptrend<0.0001) while unintentional FFIs and NFIs declined (changes=-0.01 and -0.09, respectively; Ptrend<0.0001 and 0.005). Among whites, FFIs (change=0.15; Ptrend<0.0001) and NFIs (change=0.13; Ptrend<0.0001) increased; among blacks, FFIs declined (change=-0.20; Ptrend<0.0001). Among Hispanics, FFIs declined (change=-0.28; Ptrend<0.0001) while NFIs increased (change=0.55; Ptrend=0.014). The endemic firearm-related injury rates during the first decade of the 21st century mask a shift from firearm deaths towards a rapid rise in nonfatal injuries.

The epidemiology of homicide perpetration by children

BackgroundThe United States has by far the highest rates of homicide perpetration among high-income countries. The perpetration of homicide by children is often newsworthy, but little is known about the incidence or the circumstances of child homicide perpetration.MethodsWe use data from the sixteen states reporting to the National Violent Death Reporting System (NVDRS) for all years 2005–2012. We read every violent death report that was classified a homicide with a child suspect (aged 0–14). To help ensure that we did not miss any homicide cases we also read those classified as an other-inflicted unintentional firearm injury death with a child shooter, to determine if they were actually homicides.ResultsThere were 154 child suspects, which corresponds to an average annual rate of 1.2 child perpetrators per million child population. We estimate for the United States as a whole, 74 children per year were homicide perpetrators. Nearly 90% were boys, 79% were aged 13–14, and another 13% were aged 11–12. We created five categories, which accounted for over 70% of events with sufficient information to determine what happened: (1) The caretaker, a juvenile, typically an older brother, is given the responsibility to care for an infant. The homicide usually occurs in a residence, and blunt force is used (no guns); (2) Killing an adult family member, typically a parent or grandparent. These cases usually occur in a residence, and the child uses either a gun or a knife; (3) Impulsive shooting during play, the child typically shoots a sibling or friend. Except for some notion of momentary anger, these cases look much like unintentional firearm fatalities; (4) Robbery, a group of youth are trying to steal money, usually from an adult; and (5) Group Assault, a group of youth are fighting, usually other youth.ConclusionsChild homicide perpetrators are typically boys who use guns, and the events can be classified into a small number of relevant categories. Such a categorization of events is useful for understanding the problem and determining solutions.

Adequate Funding for Injury Prevention Research Is the Next Critical Step to Reduce Morbidity and Mortality From Firearm Injuries.

Firearms are responsible for more than 33,000 deaths and 84,000 injuries every year.(1) The U.S. firearm fatality rate is the highest among all industrialized nations, with recent research demonstrating that Americans are ten times more likely to die from a firearm-related cause than residents of 22 other similar high-income countries.(2) In fact, over 80% of all firearm-related deaths due to homicides, suicides, and unintentional firearm injuries that occur in industrialized nations happen in the U.S. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved. Language: en

Migratory Bullet: Bullet Embolism into the Common Iliac Artery

Intravascular bullet embolism is a rare phenomenon encountered during autopsies of firearm fatalities. In cases where the victim has died due to firearm wounds, single entrance wounds without exits necessitate locating the bullet/projectile inside the body. This task gets tricky if the projectile enters a blood vessel and further embolises onwards with the flow of blood. We present a case of a firearm wound over the upper back with the projectile piercing the arch of aorta. Radiological investigations including CT–chest proved blank for locating any bullet inside the body. Emergency sternotomy was done but surgical exploration couldn’t find the missing bullet and the patient later succumbed to internal blood loss. Pre-autopsy x-ray showed a hypo-dense metallic shadow in the lower middle abdomen slightly to the left. The missing bullet was located inside the lumen of the common iliac artery during autopsy after tracing the track from the wound in the arch of aorta downwards. A brief summation of diagnostic & treatment protocol and autopsy findings is presented.

Gun Violence, Mental Illness, And Laws That Prohibit Gun Possession: Evidence From Two Florida Counties.

Gun violence kills about ninety people every day in the United States, a toll measured in wasted and ruined lives and with an annual economic price tag exceeding $200billion. Some policy makers suggest that reforming mental health care systems and improving point-of-purchase background checks to keep guns from mentally disturbed people will address the problem. Epidemiological research shows that serious mental illness contributes little to the risk of interpersonal violence but is a strong factor in suicide, which accounts for most firearm fatalities. Meanwhile, the effectiveness of gun restrictions focused on mental illness remains poorly understood. This article examines gun-related suicide and violent crime in people with serious mental illnesses, and whether legal restrictions on firearm sales to people with a history of mental health adjudication are effective in preventing gun violence. Among the study population in two large Florida counties, we found that 62percent of violent gun crime arrests and 28percent of gun suicides involved individuals not legally permitted to have a gun at the time. Suggested policy reforms include enacting risk-based gun removal laws and prohibiting guns from people involuntarily detained in short-term psychiatric hospitalizations.

Fatal Firearm Injuries in Tennessee: A Comparison Study of Tennessee's Two Most Populous Counties 2009-2012.

Firearm injuries are a leading cause of violent death in Tennessee. This study was designed to compare the demographic and epidemiologic features of fatal firearm injuries in Shelby County and Davidson County, Tennessee between 2009 and 2012. We identified 1081 gunshot fatalities for the study period in these two counties. Shelby County had a higher overall, age-adjusted gunshot mortality rate, a higher male age-adjusted gunshot mortality rate, and a higher age-adjusted gunshot homicide rate than Davidson. Age groups 25-34 years and 35-44 years had higher crude mortality rates for gunshot deaths in Shelby County than Davidson County. Both counties had higher age-adjusted gunshot mortality rates for black males than white males, higher homicide rate for black race than white, and higher suicide rate for white race than black. Homicide was the most common manner of death, and handguns were the most common type of firearm used in both counties.

Firearm Fatalities: A Postmortem Study in a Northeastern State of India

Firearm Fatalities: A Postmortem Study in a Northeastern State of India

English

English

Homicide by Three Different Firearms or Single Improvised Weapon: The Forensic Pathologist's Dilemma

The recovery of different constituents of ammunitions in a dead body is of vital importance for investigation of firearm fatalities. The projectile that enters the body depends on the type of firearm used. The wound of entry and the wound of exit and the track are useful guides for reconstructing the incident of firearm injury. Most often, at autopsy, these projectiles are recovered from the body and preserved as materials of evidential values. This is further complicated when changes due to decomposition obscure and modify the appearances of the wounds of the entry and exists. In our country, especially with advent of readily available improvised firearms, the classical assembly of arms and weapons are not found. Handmade or improvised firearms produce injuries that are often unique and special. Here, we report a rare case of finding one revolver bullet, one country-made rifled bullet, and one shotgun felt wad along with multiple metallic pellets, all in a single decomposed body.

Reporting on pediatric unintentional firearm injury--who's responsible.

Gun injury is a leading cause of death among US children and adolescents. Unintentional firearm death disproportionately affects youth. Reports have shown that at least a third of US homes with children have firearms. When children are fatally injured by guns, the location is most often a home, the shooter is family, the gun owner is a relative, and the gun most often originates from the home, where it was left unlocked. We conducted an Internet search of pediatric (0-18 years old) fatal and nonfatal firearm injuries from January 1 to August 31, 2014, in the United States, querying the terms shot, gun, accident, and year-old for media reports. Cases were screened for intent and coded for demographics, location, gun specifics, circumstances, relationship between the victim, shooter, gun owner, and any resultant charges. A total of 277 unintentional pediatric gun injury events were reviewed, two-thirds were nonfatal. Half of the victims were younger than 13 years; 25.3% were younger than 7 years, 80% of the victims and 85.6% of the shooters were male. Of shooters, 84.3% were the child victim themselves, a family member, or a friend/acquaintance. Seventy-seven percent of the events took place in a residence. When gun ownership was reported, 68% were owned by a family member. When charges were reported, a third were against minors. This study reinforced previous studies that unintentional child firearm injuries predominantly involve the home, family guns, young children, and males, and most could be prevented through adult responsibility for minimizing child access and securing storage of firearms. We further learned that media accounts frequently did not report on gun ownership or charges, details which might increase community awareness or inform policies useful to prevention. Shooters, not owners, were more often charged in unintentional child injuries, and minors were charged even when Child Access Prevention laws could be applied. Epidemiologic study, level 4.

Identification of bullet entrance in different type of intermediate firearm wounds through micro-computed tomography analysis

Abstract Objectives The aim of the study was to compare, by means of micro-computed tomography (micro-CT), intermediate gunshot wounds produced on human skin, in order to perform a differential diagnosis between entry (EntW) and exit (ExtW) wounds. Materials and methods Thirty firing trials were carried out at a distance of 15 cm. Six shooting experiments were performed on human calves covered with a single layer of textile; the other 24 firing trials were carried out on bare skin sections. The bare skin specimens ( n =6) and those covered by textile specimens ( n =6) were immediately formalin-fixed. The remaining gunshot wounds were submerged in water for 1 day ( n =6), or enclosed in a cowshed for 15 days ( n =6) or placed inside a wood-burning stove for 4 min ( n =6). The entrance and exit wounds were analyzed macroscopically and microscopically, as well as radiologically using a micro-CT, and the results were compared by blinded investigators. Results At visual inspection, the differential diagnosis between entrance and exit holes was possible only in fresh and submerged gunshot wounds, while the skin of the other types of lesions did not show any of the classical morphological features of entrance wounds. Micro-CT analysis detected radiopaque particles in each experimental sample only on the EntW, while on the ExtW no gunshot residue (GSR) deposits were evident. Conclusion Micro-CT analysis detected GSR in EntW, allowing the performance of a differential diagnosis from the ExtW. This objective and rapid tool may furnish precious information for reconstructing the shooting incident in firearm fatalities.

Firearm injuries in the United States

ObjectiveThis paper examines the epidemiology of fatal and nonfatal firearm violence in the United States. Trends over two decades in homicide, assault, self-directed and unintentional firearm injuries are described along with current demographic characteristics of victimization and health impact. MethodFatal firearm injury data were obtained from the National Vital Statistics System (NVSS). Nonfatal firearm injury data were obtained from the National Electronic Injury Surveillance System (NEISS). Trends were tested using Joinpoint regression analyses. CDC Cost of Injury modules were used to estimate costs associated with firearm deaths and injuries. ResultsMore than 32,000 persons die and over 67,000 persons are injured by firearms each year. Case fatality rates are highest for self-harm related firearm injuries, followed by assault-related injuries. Males, racial/ethnic minority populations, and young Americans (with the exception of firearm suicide) are disproportionately affected. The severity of such injuries is distributed relatively evenly across outcomes from outpatient treatment to hospitalization to death. Firearm injuries result in over $48 billion in medical and work loss costs annually, particularly fatal firearm injuries. From 1993 to 1999, rates of firearm violence declined significantly. Declines were seen in both fatal and nonfatal firearm violence and across all types of intent. While unintentional firearm deaths continued to decline from 2000 to 2012, firearm suicides increased and nonfatal firearm assaults increased to their highest level since 1995. ConclusionFirearm injuries are an important public health problem in the United States, contributing substantially each year to premature death, illness, and disability. Understanding the nature and impact of the problem is only a first step toward preventing firearm violence. A science-driven approach to understand risk and protective factors and identify effective solutions is key to achieving measurable reductions in firearm violence.

The epidemiology of firearm violence in the twenty-first century United States.

This brief review summarizes the basic epidemiology of firearm violence, a large and costly public health problem in the United States for which the mortality rate has remained unchanged for more than a decade. It presents findings for the present in light of recent trends. Risk for firearm violence varies substantially across demographic subsets of the population and between states in patterns that are quite different for suicide and homicide. Suicide is far more common than homicide and its rate is increasing; the homicide rate is decreasing. As with other important health problems, most cases of fatal firearm violence arise from large but low-risk subsets of the population; risk and burden of illness are not distributed symmetrically. Compared with other industrialized nations, the United States has uniquely high mortality rates from firearm violence.

Fatal firearm injuries in autopsy cases at central Bangkok, Thailand: A 10-year retrospective study

Even though there have been previously published reports on firearm injuries in various countries, the incidence and pattern of death from firearm injuries in Thailand have not been studied before. In present study, 149 fatal firearm injuries from 2002 to 2011 were reviewed. At total of 7126 autopsies, fatal firearm injuries comprised of 2.09% (n = 149) of total autopsies cases. Among those victims, 136 were male (91.3%), 13 (8.7%) were female. The youngest age of victim was 10 years and the oldest was 79 years. Mean age of the victims was 33.79 years and median age was 30 years. Outdoor incident was the most common scene of crime. Night time incident (18:00 PM–05:59 AM) was higher than day time one. Most of the cases occurred in week ends (n = 52). Homicide (77.2%) was the most frequent manner of death. Head/face and chest were the most common sites of entrance. The autopsy report also study on entrance wound, range and types of projectiles. Blood alcohol concentration was examined in 122 cases and 38 victims showed positive results, 11 cases revealed using of illegal substances in blood and urine analysis. This study also included the association between manner of death and other factors. Age group, time of incidence, place of incidence, number of entrance wound and range showed statistically significant association with manner of death.

The effect of firearm restrictions on gun-related homicides across US states

The Newtown massacre has raised the issue of gun violence to a fever pitch. While several states have responded with tough new controls on firearms, most states have loosened restrictions. This study explores what effect such changes might have on gun-related homicides in the United States. The results, based on panel data for the 50 states over the 2007–2010 period and estimated under several alternative model specifications, suggest that looser restrictions will likely do little to lessen the incidence of gun deaths but that tighter restrictions may produce a modest reduction in firearm fatalities.