Firearm injuries in the United States

Abstract

Objective: This 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.

Method: Fatal 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.

Results: More 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.

Conclusion: Firearm 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.

Keywords: Epidemiology; Firearms; Violence.

Fig. 1

Distribution of medical outcome of firearm injuries, all persons—United States, 2010–2012. Data source: National Vital Statistics System for firearm injury deaths; CDC/National Electronic Injury Surveillance System; US Census Bureau for population estimates. Rates reported are age-adjusted rates per 100,000. Hospitalizations include persons categorized as hospitalized or transferred upon discharge from the emergency department, and emergency department visits include persons treated and released from the emergency department, or who were reported to have been observed, left against medical advice, or whose disposition was unknown after presenting to the emergency department.

Fig. 2

Age-adjusted fatal and nonfatal firearm injury rates by year, United States, 1993–2012. Data source: National Vital Statistics System for firearm injury deaths; CDC/National Electronic Injury Surveillance System (NEISS) for nonfatal firearm injuries; US Census Bureau for population estimates. APC = Annual Percentage Change. Statistical significance of regression results indicated as * P < .05.

Fig. 3

Age-adjusted fatal firearm injury rates by intent and year, United States, 1993–2012. Data source: National Vital Statistics System, US Census Bureau for population estimates. APC = Annual Percentage Change. Statistical significance of regression results indicated as * P < .05, ** P < .001. Age-adjusted firearm suicide rates reflect rates for decedents 10 years of age and older.

Fig. 4

Age-adjusted nonfatal firearm injury rates by intent and year, United States, 1993–2012. Data source: CDC/National Electronic Injury Surveillance System(NEISS); US Census Bureau for population estimates. APC = Annual Percentage Change. Statistical significance of regression results indicated as * P < .05.

Fig. 5

Primary body part affected by unintentional vs. assault-related nonfatal firearm injuries—2010–2012. Data source: CDC/National Electronic Injury Surveillance System (NEISS); data obtained by request.

Fig. 6

Percentage distribution of total lifetime costs, by intent of firearm injury and disposition, United States, 2010–2012. Data source: CDC WISQARS Cost of Injury reports. Overall costs of injury are derived from work loss and medical costs combined, and are based on 2010–2012 average annual firearm injuries and deaths. Note: Total lifetime costs for fatal firearm injuries sum to $44,041,023,000; total lifetime cost for nonfatal firearm injuries sum to $4,251,361,000. By intent, unintentional firearm injuries accounted for $1,390,860,000 in total lifetime costs; self-harm/suicide firearm injuries accounted for $23,243,432,000 in total lifetime costs; and assault/homicide firearm injuries accounted for $21,767,207,000 in lifetime costs.