Global Mortality From Firearms, 1990-2016

Research output: Contribution to journalArticle

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.

Details

Authors
  • Global Burden of Disease 2016 Injury Collaborators
  • Mohsen Naghavi
  • Laurie B Marczak
  • Michael Kutz
  • Katya Anne Shackelford
  • Megha Arora
  • Molly Miller-Petrie
  • Miloud Taki Eddine Aichour
  • Nadia Akseer
  • Rajaa M Al-Raddadi
  • Khurshid Alam
  • Suliman A Alghnam
  • Carl Abelardo T Antonio
  • Olatunde Aremu
  • Amit Arora
  • Mohsen Asadi-Lari
  • Reza Assadi
  • Tesfay Mehari Atey
  • Leticia Avila-Burgos
  • Ashish Awasthi
  • Beatriz Paulina Ayala Quintanilla
  • Suzanne Lyn Barker-Collo
  • Till Winfried Bärnighausen
  • Shahrzad Bazargan-Hejazi
  • Masoud Behzadifar
  • Meysam Behzadifar
  • James R Bennett
  • Ashish Bhalla
  • Zulfiqar A Bhutta
  • Arebu Issa Bilal
  • Guilherme Borges
  • Rohan Borschmann
  • Alexandra Brazinova
  • Julio Cesar Campuzano Rincon
  • Félix Carvalho
  • Carlos A Castañeda-Orjuela
  • Lalit Dandona
  • Rakhi Dandona
  • Paul I Dargan
  • Diego De Leo
  • Samath Dhamminda Dharmaratne
  • Eric L Ding
  • Huyen Phuc Do
  • David Teye Doku
  • Kerrie E Doyle
  • Tim Robert Driscoll
  • Dumessa Edessa
  • Ziad El-Khatib
  • Aman Yesuf Endries
  • Mihajlo Jakovljevic (Contributor)
  • Aliasghar Ahmad Kiadaliri (Contributor)
Organisations
External organisations
  • University of Washington
  • Hospital for Sick Children, Toronto
  • King Abdulaziz University
  • University of Western Australia, Crawley
  • University of the Philippines
  • Birmingham City University
  • Mashhad University of Medical Sciences
  • Mekelle University
  • Public Health Foundation of India
  • University of Auckland
  • Harvard University
  • University of California, Los Angeles
  • Lorestan University of Medical Sciences
  • Aga Khan University, Pakistan
  • Addis Ababa University
  • University of Melbourne
  • Comenius University
  • University of Porto
  • National University of Colombia
  • King's College London
  • Griffith University
  • University of Peradeniya
  • Duy Tan University
  • University of Tampere
  • RMIT University
  • University of Sydney
  • Haramaya University
  • Karolinska Institutet
  • University of Kragujevac
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Health Care Service and Management, Health Policy and Services and Health Economy
Original languageEnglish
Pages (from-to)792-814
Number of pages23
JournalJAMA - Journal of the American Medical Association
Volume320
Issue number8
StatePublished - 2018 Aug 28
Publication categoryResearch
Peer-reviewedYes