Firearm-related Mortality Research Articles

Incidence, Distribution, and Lethality of Firearm Injuries in California From 2005 to 2015

Little is known about nonfatal firearm injuries in the United States, and national estimates based on emergency department samples may not be accurate. To describe the incidence and distribution of nonfatal firearm injuries and estimate case fatality ratios (CFRs) for firearm injuries by external cause of injury code within California overall and by race/ethnicity, including an assessment of trends over time and geographic variation within the state. This serial cross-sectional study used complete statewide data for firearm-related mortality, emergency department visits, and hospitalizations among California residents from January 1, 2005, through December 31, 2015, to analyze incidence, distribution, and CFRs of firearm injury. Data were analyzed from 2018 to 2019. All individuals in California with a firearm injury based on International Classification of Diseases, Ninth Revision or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes were included. Counts and rates of nonfatal firearm injuries overall and stratified by external cause, sex, and race/ethnicity; total and clinical CFRs. Clinical CFR was calculated based on individuals treated in emergency departments or hospitals. Over the study period, there were 81 085 firearm-related emergency department visits and hospitalizations among individuals with a mean (SD) age of 27.5 (11.9) years, 72 567 (89.6%) of whom were men. Nonfatal firearm injuries in California decreased by 38.1% between 2005 and 2015, driven by a 46.4% decrease in assaultive injuries. Self-inflicted injuries and unintentional injuries remained relatively stable. The overall CFR for firearm injuries increased from 27.6% in 2005 to 32.2% in 2015 for a relative increase of 20.7%, while the clinical CFR remained stable between 7.0% and 9.0%. These findings suggest that although the number of firearm injuries has decreased in California, the lethality of these injuries has not. Similar studies from other states could provide more information about these trends nationwide.

Purchaser Licensing, Point-of-Sale Background Check Laws, and Firearm Homicide and Suicide in 4 US States, 1985-2017.

Objectives. To estimate and compare the effects of state background check policies on firearm-related mortality in 4 US states.Methods. Annual data from 1985 to 2017 were used to examine Maryland and Pennsylvania, which implemented point-of-sale comprehensive background check (CBC) laws for handgun purchasers; Connecticut, which adopted a handgun purchaser licensing law; and Missouri, which repealed a similar law. Using synthetic control methods, we estimated the effects of these laws on homicide and suicide rates stratified by firearm involvement.Results. There was no consistent relationship between CBC laws and mortality rates. There were estimated decreases in firearm homicide (27.8%) and firearm suicide (23.2%-40.5%) rates associated with Connecticut's law. There were estimated increases in firearm homicide (47.3%), nonfirearm homicide (18.1%), and firearm suicide (23.5%) rates associated with Missouri's repeal.Conclusions. Purchaser licensing laws coupled with CBC requirements were consistently associated with lower firearm homicide and suicide rates, but CBC laws alone were not.Public Health Implications. Our results contribute to a body of research showing that CBC laws are not associated with reductions in firearm-related deaths unless they are coupled with handgun purchaser licensing laws.

More guns, less crime? A dynamical systems approach

The laws regulating the ownership and use of firearms by civilians have been debated in several countries. The debate arises because the relations among firearm accessibility, right to self-defense, firearm-related mortality, and violent crime statistics can suggest divergent strategies to combat criminality. Here, a model written in terms of differential equations is proposed to answer the question: do more legal guns mean less crime committed by illegal guns? From this model, the impact of distinct gun-control policies on the rate of gun-related crimes is investigated. It is analytically shown that strong gun-control leads to the minimum number of illegal guns; however, this policy does not assure a crime-free society. Weak gun-control can lead to a crime-free society; however, this policy requires the maximum number of legal guns in the hands of the civil society.

CME Questions

CME Questions| November 01 2019 CME Questions AAP Grand Rounds (2019) 42 (5): 60. https://doi.org/10.1542/gr.42-5-60 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation CME Questions. AAP Grand Rounds November 2019; 42 (5): 60. https://doi.org/10.1542/gr.42-5-60 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP News Search Advanced Search Topics: education, medical, continuing, objective (goal) The following continuing medical education questions cover the content of the November 2019 issue of AAP Grand Rounds. Please keep this issue. Each year’s material is worth up to 18 AMA PRA Category 1 Credit(s)TM. Complete and claim credit online at www.aapgrandrounds.org. Need username and password? Contact customer service at 866-843-2271. Understand the association of gluten intake during the first 5 years of life with the risk of celiac disease.Detail the risk of renal scarring with number of febrile UTIs.Describe the association of stricter firearm laws with pediatric firearm-related mortality. 2019 You do not currently have access to this content.

US Firearm-Related Mortality: National, State, And Population Trends, 1999-2017.

Nationwide firearm-related mortality rates increased in 2015-17 after remaining relatively stable in 1999-2014. Recent increases are reflected across most states and demographics to varying degrees, which suggests a worsening epidemic of firearm mortality that is geographically and demographically broad. In both time periods the fractions of firearm deaths due to suicide and homicide remained consistent.

State Gun Laws and Pediatric Firearm-Related Mortality

Firearms are the second leading cause of pediatric death in the United States. There is significant variation in firearm legislation at the state level. Recently, 3 state laws were associated with a reduction in overall deaths from firearms: universal background checks for firearm purchases, universal background checks for ammunition purchases, and identification requirement for firearms. We sought to determine if stricter firearm legislation at the state level is associated with lower pediatric firearm-related mortality. This was a cross-sectional study in which we used 2011-2015 Web-based Injury Statistics Query and Reporting System and Census data. We measured the association of the (1) strictness of firearm legislation (gun law score) and (2) presence of the 3 aforementioned gun laws with pediatric firearm-related mortality. We performed negative binomial regression accounting for differences in state-level characteristics (population-based race and ethnicity, education, income, and gun ownership) to derive mortality rate ratios associated with a 10-point change in each predictor and predicted mortality rates. A total of 21 241 children died of firearm-related injuries during the 5-year period. States with stricter gun laws had lower rates of firearm-related pediatric mortality (adjusted incident rate ratio 0.96 [0.93-0.99]). States with laws requiring universal background checks for firearm purchase in effect for ≥5 years had lower pediatric firearm-related mortality rates (adjusted incident rate ratio 0.65 [0.46-0.90]). In this 5-year analysis, states with stricter gun laws and laws requiring universal background checks for firearm purchase had lower firearm-related pediatric mortality rates. These findings support the need for further investigation to understand the impact of firearm legislation on pediatric mortality.

Family Firearm Ownership and Firearm-Related Mortality Among Young Children: 1976-2016.

Individual-level data from the National Vital Statistics System were merged with household-level data from the General Social Survey to create national-level estimates of firearm-related child mortality and family firearm ownership from 1976 to 2016 (n = 41 years). Vector autoregression models were used to examine the association between firearm ownership and child mortality. The proportion of non-Hispanic white families with young children who owned firearms declined from 50% in 1976 to 45% in 2016 and from 38% to 6% among non-Hispanic African American families. The proportion of white families with young children who owned handguns, however, increased from 25% to 32%; 72% of firearm-owning families with young children now own a handgun. Increases in handgun ownership partially explained the recent rise in firearm-related white child mortality (B = 0.426), net of economic conditions, and sociodemographic characteristics of firearm-owning families. Changes in the types of firearms in the homes of US families may partially explain recently rising firearm-related mortality among young white children. These findings hold relevance for pediatricians and policy makers aiming to reduce firearm-related mortality and promote firearm safety in children's homes.

"Smart" Choices: Shared Decision-making in Firearm Storage and Personalized Firearms.

* Abbreviation: AAP — : American Academy of Pediatrics Firearm injury is a leading cause of preventable death in children. In this issue of Pediatrics , the authors of the article “Family Firearm Ownership and Firearm-Related Mortality Among Young Children: 1976–2016” present a unique and important approach to evaluating the relationship between firearm ownership and firearm-related mortality.1 The study is novel because Prickett et al1 focus on the youngest and most vulnerable group (children <5 years of age) and evaluate trends in household gun ownership by type of firearm. Over the ∼40 years studied, Prickett et al1 found increasing firearm-related mortality rates in young children despite a downward trend in overall firearm ownership among families with young children. Most importantly, however, although overall firearm ownership decreased, the proportion of families who own handguns increased. This shift of firearm ownership from predominantly rifles (presumably for hunting) to handguns (presumably for self-protection) may provide 1 explanation for the recent increase in firearm-related mortality among young children. As firearm-related mortality in younger children is mostly unintentional, these … Address correspondence to Kavita Parikh, MD, MSHS, Division of Hospital Medicine, Children’s National Health System, 111 Michigan Ave NW, Suite 4800, Washington, DC 20010. E-mail: kparikh{at}childrensnational.org

Impact of licensed federal firearm suppliers on firearm-related mortality.

Legal firearm sales occur largely through suppliers that have Federal Firearm Licensees (FFLs). Since FFL density might reflect ease-of-access to firearm purchases, we hypothesized that the number of FFL dealers would be associated with firearm-related deaths. We further hypothesized that licensee-type subsets would be associated with differential risks for gun-related deaths. We used data from the National Center for Health Statistics National Vital Statistics System (2008-2014) and national data on Federal Firearms Licensees for 2014. Correlation analysis and linear regression analysis were performed to determine the relationship between different licensee types and firearm-related deaths. We controlled for population, number of statewide registered firearms, and the density of other types of FFLs. We identified a total of 65,297 FFLs. There was a moderate correlation (R = 0.53, ρ = 0.48) between total FFL density and firearm-related death rates. Further analysis by type of firearm-related death showed a strong correlation (R = 0.81, ρ = 0.76) between total FFL density and firearm-related suicide rates. No correlation was found between total FFL density and firearm-related homicide rate. Among individual FFL types, FFL02 (firearm dealing pawnshop) density was the only FFL-type found to be correlated with firearm-related death rates. We found a strong correlation between FFL02 density and overall firearm-related death rate (R = 0.69, ρ = 0.78) and firearm-related suicide rate (R = 0.72, ρ = 0.78). Linear regression analysis showed that even while controlling for number of registered firearms and population, the number of firearm-dealing pawnshops remained significantly associated with overall firearm-related deaths and firearm-related suicides. Access to legally distributed firearms is associated with firearm-related death rates, particularly firearm-related suicides. Specifically, firearm-dealing pawnshops were associated with suicide-related deaths. These findings suggest that deeper exploration of legal firearm access and firearm-related injuries would benefit discussion of preventative measures. Therapeutic, Level V.

Letter about “Impact of Licensed Federal Firearm Suppliers on Firearm-Related Mortality,” which has been published online ahead of print

Letter about “Impact of Licensed Federal Firearm Suppliers on Firearm-Related Mortality,” which has been published online ahead of print

An Association Between Maternal Intimate Partner Physical Violence and a Loaded Firearm in the Home

A loaded firearm in the home increases the risk of firearm-related mortality. Furthermore, firearms are often used in fatal cases of intimate partner physical violence (IPPV) during pregnancy and in the postpartum period. Young children are often caught in the crossfire. Although firearms are more prevalent in homes with IPPV compared with homes without IPPV, little is known about the relationship between a loaded firearm and maternal IPPV. The objective was to determine whether maternal IPPV in the context of additional psychosocial factors is associated with a loaded firearm in the home. We analyzed population-based survey data (2004-2011) from the Centers for Disease Control and Prevention (CDC) Pregnancy Risk Assessment Monitoring System (PRAMS) in eight states for which questions on firearms were included. Chi-square analysis of independence was used to determine differences between mothers reporting both IPPV and a loaded firearm to mothers reporting IPPV only or a loaded firearm only. Multivariable weighted logistic regression examined the association between IPPV and presence of a loaded firearm in the home (adjusting for sociodemographic and psychosocial factors). Of the 43,845 mothers in our sample, 5.3% mothers reported storing a loaded firearm in the home and 6.7% reported maternal IPPV. Among mothers reporting IPPV, 5% also reported a loaded firearm. When adjusting for sociodemographic characteristics only, maternal IPPV was significantly associated with storing a loaded firearm in the home (adjusted odds ratio [aOR] = 1.39; 95% confidence interval [CI] = [1.01, 1.91]). However, after additionally considering psychosocial factors, there was no longer a statistically significant association between maternal IPPV and storing a loaded firearm in the home (aOR = 1.31; 95% CI = [0.93, 1.84]). Contextual factors play an important role in understanding the complex relationship between maternal IPPV and the presence of a loaded firearm in the home, and maternal IPPV should be considered in efforts to promote firearm safety.

A decompositional analysis of firearm-related mortality in the United States, 2001–2012

Prior literature reporting increased rates of firearm-related homicide and suicide with increasing firearm availability is limited by only examining the availability of firearms, which is only one component of firearm-related mortality. The objective of the current study is to separate the rates into their respective components and determine which components contribute to mortality rate changes. To address the objective, nationally representative data from 2001 to 2012 was collected from a variety of publicly-available sources. Utilizing decompositional methodology, a negative binomial regression was used to estimate rate ratios for the association between the components and year category, and relative contributions of each component were calculated. From 2001 to 2012, the homicide and unintentional mortality rate decreased while the suicide rate increased. The suicide rate was only the firearm prevalence rate. The unintentional mortality rate was a factor of firearm prevalence, injury incidence, and case fatality rate. The homicide rate was a factor of firearm prevalence, violent crime rate, injury incidence, and case fatality rate. The current results suggest that the contributors of changes in firearm-related mortality are multi-faceted. Future studies should perform a decompositional analysis utilizing more granular data to examine whether the currently reported results are true associations or a factor of ecologic fallacy.

Time series robustness checks to test the effects of the 1996 Australian firearm law on cause-specific mortality

Many studies utilize time series methods to identify causal effects without accounting for an underlying time trend. We show that accounting for trends changes the conclusions in the study of Chapman et al. (JAMA, 316(3), 291–299, 2016), who evaluated the impact of the Australian firearm law in 1996. We also introduce a new empirical method that tests whether their empirical strategy can actually identify a causal effect that is also useful for panel analyses. We use national data from the Australian Bureau of Statistics, assembled in annual counts of: total firearm deaths, firearm suicides, and firearm homicides. These data are used in an independent re-analysis of the impact of the 1996 Australian firearm law that accounts for underlying stochastic trends. We then estimate a series of artificially created interruptions using interrupted times series analysis in a time frame before 1996, to test for changes in the slope of mortality across several years prior to the actual regulatory changes. This tests whether the empirical model produces effects in years other than the year of the intervention, thereby testing if the results can simply be replicated at random using other interruption years. Controlling for stochastic trends produces less statistical evidence of the impact of the firearm law on firearm mortality than previously reported by Chapman et al. (JAMA, 316(3), 291–299, 2016). Introducing artificial interruptions in 1990 through 1995 produces statistically significant decreases in all firearm-related mortality measures well above the expected type 1 error. Overall, 19 out of the 36 artificial interruption models we tested were found to be statistically significant, suggesting that the empirical model can be implemented in multiple non-intervention years with results similar to the true 1996 interruption year. Current evidence showing decreases in firearm mortality after the 1996 Australian national firearm law relies on an empirical model that may have limited ability to identify the true effects of the law.

Firearm Legislation and Firearm Mortality in the USA

Summary 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 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.

Firearm legislation and firearm mortality in the USA: a cross-sectional, state-level study.

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. 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. 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. 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. None.

Pediatric Firearm Injuries: Do Database Analyses Tell the Whole Story?

Firearm injuries cause significant morbidity and mortality in the pediatric population and a large economic burden to our health care system. Recent events have increased awareness in the public and in turn for those in the medical field. Many local and national studies have evaluated various aspects of firearm-related injuries across the United States in an effort to identify an intervention that may assist with prevention or management of firearm-related injuries or death in this vulnerable population. In the 1990s, there was a significant decrease in pediatric firearm-related injuries and mortality. The reason for this decline remains unknown with many theories including improved laws, increased awareness, and increased prevention efforts. However, this trend did not continue into the 21st century, and firearms remain one of the leading causes of death in the pediatric population.

The epidemiology of trauma-related mortality in the United States from 2002 to 2010

Epidemiologic trends in trauma-related mortality in the United States require updating and characterization. We hypothesized that during the past decade, there have been changing trends in mortality that are associated with multiple public health and health care-related factors. Multiple sources were queried for the period of 2002 to 2010: the National Trauma Data Bank, the National Centers for Disease Control, the National Highway Traffic Safety Administration, the Nationwide Emergency Department Sample, and the US Census Bureau. The incidence of injury and mortality for motor vehicle traffic (MVT) collisions, firearms, and falls were determined using National Centers for Disease Control data. National Highway Traffic Safety Administration data were used to determine motor vehicle collision information. Injury severity data were derived from the Nationwide Emergency Department Sample and National Trauma Data Bank. Analysis of mortality trends by year was performed using the Cochran-Armitage test for trend. Time-trend multivariable Poisson regression was used to determine risk-adjusted mortality over time. From 2002 to 2010, the total trauma-related mortality decreased by 6% (p < 0.01). However, mortality trends differed by mechanism. There was a 27% decrease in the MVT death rate associated with a 20% decrease in motor vehicle collisions, 19% decrease in the number of occupant injuries per collision, lower injury severity, and improved outcomes at trauma centers. While firearm-related mortality remained relatively unchanged, mortality caused by firearm suicides increased, whereas homicide-associated mortality decreased (p < 0.001 for both). In contrast, fall-related mortality increased by 46% (5.95-8.70, p < 0.01). MVT mortality rates have decreased during the last decade, owing in part to decreases in the number and severity of injuries. Conversely, fall-related mortality is increasing and is projected to exceed both MVT and firearm mortality rates should current trends continue. Trauma systems and injury prevention programs will need to take into account these changing trends to best accommodate the needs of the injured population. Epidemiologic study, level III.

Firearm-related deaths in Brescia (Northern Italy) between 1994 and 2006: A retrospective study

This retrospective study analyzes post-mortem examination data of 164 firearm-related casualties recorded by the Brescia, Italy Institute of Forensic Medicine between the years 1994 and 2006. The following variables were considered: year, month and day of death, gender and age of the victim, manner of death (homicide, suicide, accidental), type of weapon used, anatomical site and number of wounds, scene of death, and, whenever requested by the local District Attorney’s Office, results of the toxicological examinations conducted on the corpses of the deceased. In the County of Brescia, Italy, the 2006 firearm-related mortality rate amounted to 0.84 per 100,000 residents, with an average of 12.6 cases per year. The most common manner of death was suicide (60.4%), followed by homicide (35.9%) and accidental death (3.7%). Most victims were male, with an average age of 47.2 in cases of suicide, 37.9 in cases of homicide, and 47.5 in cases of accidental death. Considering all of the death manners contemplated in this study, the weapon types most frequently resorted to were single-action, short-barrelled guns, followed by multiple-action, long-barrelled ones. In cases of suicide, entry wounds were primarily situated on the head (right temple) and chest (precordium), while in cases of homicide no conclusions could be drawn as to the entry wounds’ predominant location.

CAEP Position Statement on Gun Control

EXECUTIVE SUMMARYFirearm-related injury and death continue to be a significant problem in Canada. Since the 1990s Canadian emergency physicians (EPs) have played an active role in advocating for gun control. This paper updates the Canadian Association of Emergency Physician's (CAEP's) position on gun control. Despite a media focus on homicide, the majority of firearm-related deaths are a result of suicide. Less than 40% of firearm-related injuries are intentionally inflicted by another person. Since the implementation of Canada's gun registry in 1995, there has been a significant reduction in firearm-related suicides and intimate partner homicides. Proposed weakening of gun laws in Canada will have a significant impact on firearm-related mortality and injury. There must be instead an expansion of programs focused on prevention of suicide, intimate partner violence and gang-related violence.The majority of intentional or unintentional firearm-related injuries involve a violation of safe storage or handling practice. The potential for future harm because of unsafe storage or handling or through gang conflict retribution supports our position that health care facilities report gunshot wounds (GSWs). Moreover, a nationwide surveillance system is necessary to support research and to guide future public policy development and legislation.As EPs we must advocate for injury control. All firearm injuries and deaths are preventable, and we must advocate for a multifaceted approach in order to minimize this risk to our patients.

Reductions In Firearm-Related Mortality And Hospitalizations In Brazil After Gun Control

This paper provides evidence suggesting that gun control measures have been effective in reducing the toll of violence on population health in Brazil. In 2004, for the first time in more than a decade, firearm-related mortality declined 8 percent from the previous year. Firearm-related hospitalizations also reversed a historical trend that year by decreasing 4.6 percent from 2003 levels. These changes corresponded with anti-gun legislation passed in late 2003 and disarmament campaigns undertaken throughout the country since mid-2004. The estimated impact of these measures, if they prove causal, could be as much as 5,563 firearm-related deaths averted in 2004 alone.