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Dhand R, Okumura K, Nishida S, Dhand A. Rise in deaths from drug overdose and firearm injury during coronavirus disease 2019 pandemic and its impact on organ transplantation. World J Transplant 2025; 15:101986. [DOI: 10.5500/wjt.v15.i2.101986] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Revised: 10/30/2024] [Accepted: 11/20/2024] [Indexed: 02/21/2025] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic had a profound societal impact in the United States which was associated with a decrease in overall life expectancy and an increase in substance abuse and firearm injury. Our understanding of changes in mortality trends during the pandemic and its effect on organ availability for transplantation is limited.
AIM To examine the trends of substance abuse and firearm injury fatalities during COVID-19 and a potential correlation with organ transplantation.
METHODS Crude rates of population-based deaths among adults (18-75 years) from firearm injury and substance abuse from the period of 2014-2021 were obtained from centers of disease control wide-ranging online data for epidemiologic research database. Crude rates of causes of donor (18-75 years) deaths from 2014-2021 were obtained from the united network for organ sharing database.
RESULTS Average annual percentage change (AAPC) deaths among the United States population were 16.4% from substance abuse and 3.4% from firearm injury. AAPC in cause of death among organ donors was 10.9% from drug intoxication and 2.1% from firearm injury. There was a significant (P < 0.001) and progressive increase in mortality from both causes during the pandemic (2020-2021) and significant correlation (P < 0.001) between population and donor causes of death. COVID-19 exacerbated trends in substance abuse and firearm mortality with a consequent increase in organ donation from donors who died from these two causes.
CONCLUSION Identifying the socioeconomic and regional disparities associated with increase in deaths from substance abuse and firearms can help guide post-pandemic healthcare policies and mitigate their impact on organ transplantation.
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Affiliation(s)
- Roshan Dhand
- Horace Greeley High School, Chappaqua, NY 10514, United States
| | - Kenji Okumura
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY 10595, United States
| | - Seigo Nishida
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY 10595, United States
| | - Abhay Dhand
- Department of Surgery and Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY 10595, United States
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Choi HM, Heo S, Bell ML. Temporal trends in the association between temperature and firearm mortality. ENVIRONMENTAL RESEARCH 2025; 275:121384. [PMID: 40081650 DOI: 10.1016/j.envres.2025.121384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Revised: 03/02/2025] [Accepted: 03/10/2025] [Indexed: 03/16/2025]
Abstract
INTRODUCTION Firearm violence is a leading cause of mortality in the U.S., with recent evidence linking increased firearm incidents to high temperatures, disproportionately affecting those in lower socioeconomic status. This study analyzes firearm mortality trends attributed to high temperatures in Alabama and Georgia (2000-2020), focusing on differences by race/ethnicity and sex, to inform targeted interventions and address health inequities. METHODS We analyzed a total of 44,957 individual-level firearm mortality data (2000-2020) from Alabama and Georgia, two states with the highest firearm death rates. Using a time-stratified case-crossover using conditional logistic regression with distributed lag non-linear models (DLNM), we estimated annual attributable fractions (AFs) of firearm deaths linked to temperatures above the 90th temperature percentile, with stratified analyses by race/ethnicity and sex to identify vulnerable populations. RESULTS From 2000 to 2020, heat AFs for firearm mortality rose by 0.05 % (95 % CI: -0.01, 0.12) per year. Females showed a higher annual average percent increase (APC) in heat-related AF of 0.12 % (95 % CI: -0.03, 0.28) compared to males (APC: 0.02 % (95 % CI: -0.04, 0.08)). Black/African Americans experienced a higher APC of 0.10 % (95 % CI: 0.01, 0.19) than the White population with APC of 0.02 (95 % CI: -0.06, 0.09). DISCUSSION Extreme heat contributed to increases in firearm mortality in Alabama and Georgia, with varying health impacts across sex and racial/ethnic groups. Raising awareness of the impact of heat on firearm mortality within public health initiatives is crucial for enhancing community protection against climate change.
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Affiliation(s)
- Hayon Michelle Choi
- School of the Environment, Yale University, CT, USA; Harvard T.H. Chan School of Public Health, MA, USA.
| | - Seulkee Heo
- School of the Environment, Yale University, CT, USA
| | - Michelle L Bell
- School of the Environment, Yale University, CT, USA; Korea University, Seoul, South Korea
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Akande MO, Carbone JT, Vaughn MG, Jackson DB, Crifasi CK. Trends and Disparities in Firearm Injuries Among Emerging Adults: A 15-Year Analysis of Emergency Department Admissions in the U.S. AJPM FOCUS 2025; 4:100332. [PMID: 40290862 PMCID: PMC12033906 DOI: 10.1016/j.focus.2025.100332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/30/2025]
Abstract
Introduction Firearm injuries in the U.S. are rising, with emerging adults (aged 18-24 years) experiencing disproportionately high rates of fatal and nonfatal incidents. This study examines trends, intent-specific patterns, and disparities in fatal and nonfatal firearm injuries among this high-risk age group. Methods Data were from the Healthcare Cost and Utilization Project's Nationwide Emergency Department Sample (2006-2020), analyzing emergency department admissions for firearm injuries among participants aged 18-24 years. Firearm injuries were classified by intent (assault, unintentional, intentional self-injury, undetermined, other) using International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification diagnosis codes. Trend analyses, descriptive statistics, and logistic regression models were employed to identify patterns and associations by intent and key socioeconomic and geographic indicators. Analysis was conducted in April 2024. Results Firearm injuries increased annually during Quarter 3 and spiked during the COVID-19 pandemic, particularly for unintentional injuries and assaults. Males had significantly higher odds of firearm injury admissions across all intents than females. Intentional self-injury was more prevalent in rural areas, whereas assault and unintentional injuries were higher in urban areas and among those with Medicaid/Medicare insurance or uninsured. Firearm injury admissions were more likely among individuals from ZIP codes with lower median household incomes, except for intentional self-injury, which showed unique patterns across most indicators. The Northeast had substantially lower firearm-related emergency department admissions across all intents than other U.S. regions. Conclusions Findings underscore the need for comprehensive strategies to mitigate firearm injuries among emerging adults in the U.S. The significant increase in unintentional firearm injuries and assaults during COVID-19, coupled with the decline in nonfirearm injuries during this time, underscores the complex interplay of social isolation, increased firearm exposure, and broader societal disruptions. Disparities based on sex, insurance status, and geography further emphasize the necessity for public health interventions. Addressing these multifactorial influences and disparities is essential to developing effective, evidence-based policies. Future research should prioritize enhancing data collection on nonfatal firearm injuries and standardizing reporting systems to support these efforts.
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Affiliation(s)
- Morayo O. Akande
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jason T. Carbone
- School of Social Work, Wayne State University, Detroit, Michigan
| | | | - Dylan B. Jackson
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Cassandra K. Crifasi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Gu W, Greenwood BN, Agarwal R, Nestadt PS. The Impact of Extreme Risk Protective Orders on Firearm Fatalities. Am J Prev Med 2025:107652. [PMID: 40349740 DOI: 10.1016/j.amepre.2025.107652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 04/10/2025] [Accepted: 04/12/2025] [Indexed: 05/14/2025]
Abstract
INTRODUCTION Although a growing number of states have implemented Extreme Risk Protective Orders (ERPOs) to curb gun violence, existing studies on ERPOs have been limited in scope, focusing on a few states, and often lacking robust methodologies to identify their effects. In this work, we estimate the effect of ERPO codification on firearm fatalities (homicides and suicides). Further, we examine heterogeneity in fatalities across racial subpopulations and those who can petition for such restrictions (viz. law enforcement, family members, healthcare professionals). METHODS Using a difference in difference approach, we estimate changes in outcomes across nineteen treated states and the District of Columbia which implemented ERPOs, and thirty-one control states. The sample runs from 1998 to 2020, including 288,250 homicides and 450,956 suicides involving firearms. Data are drawn from National Center for Health Statistics (NCHS) death certificates. RESULTS Empowering health professional petitioners significantly reduces suicides overall, most prominently among White victims (-14.79% [95% CI, -19.18% to -10.24%], 7∼16 state yearly net effect). Including family members as petitioners significantly decreases homicides overall, and most prominently among Black victims to varying degrees in most models. CONCLUSIONS Results indicate significant differences in the efficacy of ERPO implementation on firearm-related homicides and suicides across petitioners and subpopulations. Our study underscores the benefits of diversified petitioners and their role in ending violence across different communities.
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Affiliation(s)
- Wenying Gu
- Decision, Operations, and Information Technologies, Robert H. Smith School of Business, University of Maryland, College Park, MD, USA
| | - Brad N Greenwood
- Costello College of Business, George Mason University, Fairfax, VA, USA
| | - Ritu Agarwal
- Center for Digital Health and Artificial Intelligence (CDHAI), Johns Hopkins Carey Business School, Johns Hopkins University, MD, USA
| | - Paul S Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Johns Hopkins University, MD, USA.
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Cafferky V, Sun S, Saadeh FB, Loucks EB. Identifying the Changing Landscape of Younger Adult Mortality in the United States from 1999 to 2021. J Adolesc Health 2025; 76:571-583. [PMID: 39985531 PMCID: PMC11930608 DOI: 10.1016/j.jadohealth.2024.11.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 10/25/2024] [Accepted: 11/26/2024] [Indexed: 02/24/2025]
Abstract
PURPOSE To evaluate temporal trends and drivers of mortality among younger adults (aged 18-39), from 1999 to 2021. METHODS Observational study using nationally representative United States mortality data from 1999 to 2021, acquired via the US Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research database. Exposure of interest was cause of death. Primary outcomes were population-level mortality rates and percent increase from 1999 to 2021. Secondary outcomes were cause-specific and subgroup-specific (sex, race, ethnicity) mortality rates and percent increases. RESULTS From 1999 to 2021, US younger adults aged 18-39 experienced a 54.1% increase in annual mortality (from 113.4 deaths per 100,000 in 1999 to 174.7 deaths per 100,000 in 2021; Cochran-Armitage p < .0001). Before COVID, from 1999 to 2019, younger adults experienced a 10.8% increase in mortality, compared to a 1.5% increase among the broader US population. The top driver of increased younger adult mortality, from 1999 through 2021, was accidental poisoning and exposure to noxious substances. Mortality trends varied by demographic variables with notable increases among American Indian/Alaskan Native Americans. DISCUSSION US younger adults are suffering from rising premature mortality. Resources should be calibrated to better support this generation.
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Affiliation(s)
- Virginia Cafferky
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
| | - Shufang Sun
- Department of Behavioral Sciences, Brown University School of Public Health, Providence, Rhode Island; Mindfulness Center, Brown University, Providence, Rhode Island
| | - Frances B Saadeh
- Mindfulness Center, Brown University, Providence, Rhode Island; School of Professional Studies, Brown University, Providence, Rhode Island
| | - Eric B Loucks
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island; Department of Behavioral Sciences, Brown University School of Public Health, Providence, Rhode Island; Mindfulness Center, Brown University, Providence, Rhode Island
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6
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Walsh CS, Sullivan TN, Kliewer W, Ross KM. A Qualitative Scoping Review of Community Firearm Violence in Low-Income Settings. J Community Health 2025; 50:287-305. [PMID: 39467960 PMCID: PMC11937192 DOI: 10.1007/s10900-024-01419-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2024] [Indexed: 10/30/2024]
Abstract
Firearm violence is a public health crisis in the United States that disproportionately impacts community members in low-income areas who witness and experience violence and violent victimization at elevated rates compared to other socioeconomic groups, often as result of community disinvestment and systemic racism (Smith et al., Soc Sci Med 246:112587, 2020). While quantitative reviews of firearm violence and related factors exist, a review of qualitative methods and findings regarding exposure to firearm violence has not yet been conducted. This scoping review sought to address a gap in the literature by summarizing the findings of qualitative studies on community firearm violence in low-income settings in the U.S. EBSCO databases, Criminal Justice Abstracts, National Criminal Justice Reference Service Abstracts, ProQuest, and PsycINFO were searched for studies that described the firearm related experiences of individuals and families in low-income communities. Thirty studies met the criteria for review. Findings were situated within the Centers for Disease Control and Prevention's (CDC) Social-Ecological Model as a framework for prevention (CDC, The social-ecological model: a framework for prevention, https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html , 2018; Dahlberg and Krug, World Report on violence and health, World Health Organization, Geneva, 2002). A critique of the literature, as well as implications and future directions of findings, are discussed. This study may inform future research questions and programs that center the voices of those most impacted by firearm violence.
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Affiliation(s)
- Colleen S Walsh
- Department of Psychology, Vanderbilt University, 230 Appleton Place, Nashville, TN, USA.
| | - Terri N Sullivan
- Department of Psychology, Virginia Commonwealth University, P. O. Box 842018, Richmond, VA, 23284, USA
| | - Wendy Kliewer
- Department of Psychology, Virginia Commonwealth University, P. O. Box 842018, Richmond, VA, 23284, USA
| | - Katherine M Ross
- Search Institute, 3001 Broadway Street NE #310, Minneapolis, MN, 55413, USA
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7
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Hemenway D, Azrael D, Barber C, Fischer S, Miller M. Black and White Demographic Patterns of Gun Ownership and Suicide, 2021. Arch Suicide Res 2024:1-9. [PMID: 39520677 DOI: 10.1080/13811118.2024.2427271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
OBJECTIVE We use 2021 data to compare the demographic patterns of adult White and Black gun ownership with their respective race-specific rates of firearm, non-firearm and total suicide, and the percentage of suicides using firearms. METHODS Data on gun ownership came from a nationally representative sample of over 19,000 respondents to the 2021 National Firearms Survey. Both race-specific gun ownership and suicide rates were stratified by respondent demographics-sex (male, female), census region (Northeast, South, Midwest, West), urbanicity (metropolitan or non-metropolitan), and age (18-29, 30-44, 45-59, 60+). RESULTS White adults reported higher rates of gun ownership than did Black adults (33% vs 24%) but a firearm was used in a similar percentage of suicides (56% vs 58%). The demographic patterns of gun ownership of White and Black adults were similar-those least likely to report owning firearms were females, those living in the Northeast, residents of metropolitan areas, and younger adults. But the suicide patterns were somewhat different-whereas suicide rates among White adults were highest among older Whites and among Whites in non-metropolitan areas, suicide rates among Black adults were highest among younger Blacks and similar in metropolitan and non-metropolitan areas. CONCLUSIONS The self-reported levels and patterns of Black gun ownership cannot explain why such a high percentage of Black suicides are firearm suicides or why firearm and total suicide rates of Black adults fall so dramatically with age.
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Ancona RM, Cooper BP, Foraker R, Kaser T, Adeoye O, Mueller KL. Machine learning classification of new firearm injury encounters in the St Louis region: 2010-2020. J Am Med Inform Assoc 2024; 31:2165-2172. [PMID: 38976592 DOI: 10.1093/jamia/ocae173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/10/2024] Open
Abstract
OBJECTIVES To improve firearm injury encounter classification (new vs follow-up) using machine learning (ML) and compare our ML model to other common approaches. MATERIALS AND METHODS This retrospective study used data from the St Louis region-wide hospital-based violence intervention program data repository (2010-2020). We randomly selected 500 patients with a firearm injury diagnosis for inclusion, with 808 total firearm injury encounters split (70/30) for training and testing. We trained a least absolute shrinkage and selection operator (LASSO) regression model with the following predictors: admission type, time between firearm injury visits, number of prior firearm injury emergency department (ED) visits, encounter type (ED or other), and diagnostic codes. Our gold standard for new firearm injury encounter classification was manual chart review. We then used our test data to compare the performance of our ML model to other commonly used approaches (proxy measures of ED visits and time between firearm injury encounters, and diagnostic code encounter type designation [initial vs subsequent or sequela]). Performance metrics included area under the curve (AUC), sensitivity, and specificity with 95% confidence intervals (CIs). RESULTS The ML model had excellent discrimination (0.92, 0.88-0.96) with high sensitivity (0.95, 0.90-0.98) and specificity (0.89, 0.81-0.95). AUC was significantly higher than time-based outcomes, sensitivity was slightly (but not significantly) lower than other approaches, and specificity was higher than all other methods. DISCUSSION ML successfully delineated new firearm injury encounters, outperforming other approaches in ruling out encounters for follow-up. CONCLUSION ML can be used to identify new firearm injury encounters and may be particularly useful in studies assessing re-injuries.
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Affiliation(s)
- Rachel M Ancona
- Department of Emergency Medicine, Washington University in St Louis, St Louis, MO 63110, United States
| | - Benjamin P Cooper
- Institute for Public Health, Washington University in St Louis, St Louis, MO 63110, United States
| | - Randi Foraker
- Department of Medicine, Washington University in St Louis, St Louis, MO 63110, United States
| | - Taylor Kaser
- Department of Emergency Medicine, Washington University in St Louis, St Louis, MO 63110, United States
| | - Opeolu Adeoye
- Department of Emergency Medicine, Washington University in St Louis, St Louis, MO 63110, United States
| | - Kristen L Mueller
- Department of Emergency Medicine, Washington University in St Louis, St Louis, MO 63110, United States
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Bovio NR, Brooks JK, Prahlow JA. Suicide by Gunshot Wound to the Posterior Head and Neck: A Retrospective Case Series and Review of the Literature. Am J Forensic Med Pathol 2024; 45:248-253. [PMID: 38471138 DOI: 10.1097/paf.0000000000000925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
ABSTRACT Suicide by firearm is a significant public health concern in specific regions of the world. Depending on firearm availability, any type of firearm may be used, including handguns, shotguns, and long rifles. Common entrance wound sites in suicidal gunshot wounds include the head, with classic gunshot wound locations including the temple, the forehead, the submental aspect of the chin, and inside the mouth. Occasionally, suicidal gunshot wounds occur in atypical body locations such as the back of the head and neck. Given their relative rarity, suicidal gunshot wounds in these regions may be mistaken for homicides. In this report, we present 5 cases of suicidal gunshot wounds to the back of the head and/or neck. In our series, we focus on differentiating each case from homicides involving gunshot wounds in similar areas of the head and neck.
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Affiliation(s)
- Nicholas R Bovio
- From the Department of Pathology, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI
| | - Jared K Brooks
- From the Department of Pathology, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI
| | - Joseph A Prahlow
- Department of Pathology, St Louis University School of Medicine, St Louis, MO
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DeBlieux PJ, Alexander LF, Nookala N, Nereim C. A Review of Community-Based Gun Violence Prevention Programs and the Physician's Role. Adv Pediatr 2024; 71:41-54. [PMID: 38944488 DOI: 10.1016/j.yapd.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Gun violence (GV) and safety is a contentious topic in the United States, despite increasing morbidity and mortality among children and adolescents. It is important for physicians to take a role in preventing future GV. This article aims to present several methods that physicians can use to prevent GV in their own communities, ranging from implementation of large-scale intervention programs to simple screenings and anticipatory guidance. As the problem of GV persists, it is important for physicians to use their role to identify individuals who are at high-risk and advocate for changes that will benefit their future health.
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Affiliation(s)
- Paige J DeBlieux
- General Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Lara F Alexander
- Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, NC, USA
| | | | - Cameron Nereim
- USF Health Morsani College of Medicine, Tampa, FL, USA; Department of Pediatrics, USF Health Morsani College of Medicine, Tampa, FL, USA.
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Valenti J, Posner K, Nadeau N, Bakus C, Richards S. Comments on the Article "Orthopedic Patients with Mental Disorder: Literature Review on Preoperative and Postoperative Precautions": To the Editor. Clin Orthop Surg 2024; 16:342-345. [PMID: 38562633 PMCID: PMC10973630 DOI: 10.4055/cios23323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/12/2023] [Indexed: 04/04/2024] Open
Affiliation(s)
| | - Kevin Posner
- Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | | | | | - Sean Richards
- Hackensack Meridian School of Medicine, Nutley, NJ, USA
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12
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Waller BY, Joseph VA, Keyes KM. Racial inequities in homicide rates and homicide methods among Black and White women aged 25-44 years in the USA, 1999-2020: a cross-sectional time series study. Lancet 2024; 403:935-945. [PMID: 38342127 PMCID: PMC11018094 DOI: 10.1016/s0140-6736(23)02279-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND In the USA, Black women aged 25-44 years are disproportionately murdered compared with their White counterparts. Despite ongoing efforts to reduce racial and structural inequities, the result of these efforts remains unclear, particularly in light of the COVID-19 pandemic. METHODS This study examined a cross-sectional time series of homicide death rates, by race, from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research system. We included data for women aged 25-44 years between 1999 and 2020 among 30 states in the USA. Homicide death was classified using underlying cause and multiple cause of death codes; mortality rates were calculated per 100 000 based on US Census Bureau population sizes. Homicide methods were classified as firearm, cutting or piercing, and other. Firearm homicides were compared with other homicides with logistic regression including covariates of race, time, and their interaction. We report odds ratios and 95% CIs. FINDINGS In 2020, the homicide rate among Black women was 11·6 per 100 000, compared with 3 per 100 000 among White women. This inequity has persisted over time and is virtually unchanged since 1999. Homicide inequities vary across US states; in 11 states, racial inequities have increased since 1999. The racial inequity was greatest in Wisconsin, where in 2019-20, Black women aged 25-44 years were 20 times more likely to die by homicide than White women. Homicide by firearm is increasing in frequency; women in the USA had 2·44 (95% CI 2·14-2·78) times the odds of homicide involving firearms in 2019-20 compared with 1999-2003. Firearm homicide deaths are disproportionately concentrated among Black women in every region in the USA. INTERPRETATION Our findings suggest that there is an urgent need to address homicide inequities among Black and White women in the USA. Enacting federal legislation that reduces gun access is a crucial step. Policy makers must address long-standing structural factors that underpin elevated gun violence by implementing sustainable wealth-building opportunities; developing desegregated, mixed income and affordable housing; and increasing green spaces in communities where Black women largely reside. FUNDING National Institute of Mental Health of the National Institutes of Health.
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Affiliation(s)
- Bernadine Y Waller
- Department of Psychiatry, Columbia University Irving Medical Center-New York State Psychiatric Institute, New York, NY, USA.
| | - Victoria A Joseph
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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13
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Polcari AM, Slidell MB, Hoefer LE, Henry MC, Zakrison TL, Rogers SO, Benjamin AJ. Social Vulnerability and Firearm Violence: Geospatial Analysis of 5 US Cities. J Am Coll Surg 2023; 237:845-854. [PMID: 37966089 DOI: 10.1097/xcs.0000000000000845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Firearm violence is now endemic to certain US neighborhoods. Understanding factors that impact a neighborhood's susceptibility to firearm violence is crucial for prevention. Using a nationally standardized measure to characterize community-level firearm violence risk has not been broadly studied but could enhance prevention efforts. Thus, we sought to examine the association between firearm violence and the social, structural, and geospatial determinants of health, as defined by the Social Vulnerability Index (SVI). STUDY DESIGN In this cross-sectional study, we merged 2018 SVI data on census tract with shooting incidents between 2015 and 2021 from Baltimore, Chicago, Los Angeles, New York City, and Philadelphia. We used negative binomial regression to associate the SVI with shooting incidents per 1,000 people in a census tract. Moran's I statistics and spatial lag models were used for geospatial analysis. RESULTS We evaluated 71,296 shooting incidents across 4,415 census tracts. Fifty-five percent of shootings occurred in 9.4% of census tracts. In all cities combined, a decile rise in SVI resulted in a 37% increase in shooting incidents (p < 0.001). A similar relationship existed in each city: 30% increase in Baltimore (p < 0.001), 50% in Chicago (p < 0.001), 28% in Los Angeles (p < 0.001), 34% in New York City (p < 0.001), and 41% in Philadelphia (p < 0.001). Shootings were highly clustered within the most vulnerable neighborhoods. CONCLUSIONS In 5 major US cities, firearm violence was concentrated in neighborhoods with high social vulnerability. A tool such as the SVI could be used to inform prevention efforts by directing resources to communities most in need and identifying factors on which to focus these programs and policies.
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Affiliation(s)
- Ann M Polcari
- From the Department of Surgery, The University of Chicago Medicine, Chicago, IL (Polcari, Hoefer)
| | - Mark B Slidell
- From the Department of Surgery, The University of Chicago Medicine, Chicago, IL (Polcari, Hoefer)
| | - Lea E Hoefer
- From the Department of Surgery, The University of Chicago Medicine, Chicago, IL (Polcari, Hoefer)
| | - Marion Cw Henry
- From the Department of Surgery, The University of Chicago Medicine, Chicago, IL (Polcari, Hoefer)
| | - Tanya L Zakrison
- From the Department of Surgery, The University of Chicago Medicine, Chicago, IL (Polcari, Hoefer)
| | - Selwyn O Rogers
- From the Department of Surgery, The University of Chicago Medicine, Chicago, IL (Polcari, Hoefer)
| | - Andrew J Benjamin
- From the Department of Surgery, The University of Chicago Medicine, Chicago, IL (Polcari, Hoefer)
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Pless Kaiser A, Chennapragada L, Andrusier S, Silver C, Padgett C, Beaudreau SA, Fairchild JK, Goodman M. Firearm Safety and Suicide Prevention for Medically Complex Older Veterans: Perspectives of VA Home-Based Primary Care Directors and Psychologists. Clin Gerontol 2023:1-12. [PMID: 37767999 DOI: 10.1080/07317115.2023.2263218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
OBJECTIVES Determine strategies and resources used by VA Home-Based Primary Care (HBPC) teams to discuss firearm safety and suicide risk with older veterans and their families or caregivers. Training and resource needs for promoting firearm safety with older veterans were also ascertained. METHODS Ten focus groups (N = 37) were conducted virtually in 2022 with HBPC directors and psychologists. Qualitative rapid response coding identified domains and themes within transcripts. RESULTS Analysis revealed three major domains: firearm safety, suicide risk, and resources/trainings. Firearm safety themes included discussions during clinical procedures, firearm-related challenges, veteran culture, and barriers and facilitators to effective conversations. Suicide risk themes included assessment procedures, frequency/types of risk conversations, factors related to suicidal ideation/behavior, challenges, and strategies to enhance communication. Resource/training themes included those currently used and perceived needs. CONCLUSIONS Participants described strategies for facilitating firearm safety and suicide prevention discussions with older veterans, their families, and caregivers. Using respectful language and attending to values related to firearm ownership were identified as essential. CLINICAL IMPLICATIONS Additional clinician/staff training/resources are needed for addressing older veteran firearm safety and suicide risk, including how to conduct more effective conversations with older veterans on these topics and better engage families/caregivers in prevention efforts.
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Affiliation(s)
- Anica Pless Kaiser
- Behavioral Science Divison, National Center for PTSD, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Lakshmi Chennapragada
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J Peters Veteran Affairs Medical Center, Bronx, New York, USA
| | - Sarah Andrusier
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J Peters Veteran Affairs Medical Center, Bronx, New York, USA
| | - Chana Silver
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J Peters Veteran Affairs Medical Center, Bronx, New York, USA
| | - Cameron Padgett
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J Peters Veteran Affairs Medical Center, Bronx, New York, USA
| | - Sherry A Beaudreau
- Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - J Kaci Fairchild
- Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Marianne Goodman
- VISN 2 Mental Illness Research, Education, and Clinical Center (MIRECC), James J Peters Veteran Affairs Medical Center, Bronx, New York, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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