Saturday, December 8, 2012

University of Utah Medical School: Guns, Public Health and Safety

Gun Control Issues, Public Health, and Safety

Gunshot wounds impact severely on the criminal justice as well as health care systems. Some basic statistics are important in understanding the magnitude and severity of the social and economic burden to the U.S. The subject remains contentious. (Glantz and Annas, 2009)

In the U.S. for 2010, there were 31,513 deaths from firearms, distributed as follows by mode of death: Suicide 19,308; Homicide 11,015; Accident 600. This makes firearms injuries one of the top ten causes of death in the U.S. The number of firearms-related injuries in the U.S., both fatal and non-fatal, increased through 1993, declined to 1999, and has remained relatively constant since. However, firearms injuries remain a leading cause of death in the U.S., particularly among youth (CDC, 2001) (Sherry et al, 2012).

The rates of firearms deaths in the U.S. vary significantly by race and sex. The U.S. national average was 10.2 deaths per 100,000 population in 2009. The highest rate was 28.4/100,000 for African-American males, more than quadruple the rate of 6.3/100,000 for white males. (CDC, 2009)

The number of non-fatal injuries is considerable--over 200,000 per year in the U.S. Many of these injuries require hospitalization and trauma care. A 1994 study revealed the cost per injury requiring admission to a trauma center was over $14,000. The cumulative lifetime cost in 1985 for gunshot wounds was estimated to be $911 million, with $13.4 billion in lost productivity. (Mock et al, 1994) The cost of the improper use of firearms in Canada was estimated at $6.6 billion per year. (Chapdelaine and Maurice, 1996)

A study of firearm deaths in high income countries (Australia, Austria, Canada, Czech Republic, Finland, France, Germany, Hungary, Iceland, Italy, Japan, Luxembourg, Netherlands, New Zealand, Norway, Portugal, Slovakia, Spain, Sweden, United Kingdom (England and Wales), United Kingdom (Northern Ireland), United Kingdom (Scotland), and the United States) was conducted with data from the World Health Organization assembled by the WHO from the official national statistics of each individual country from 2003 (Richardson and Hemenway, 2011). The total population for the United States for 2003 was 290.8 million while the combined population for the other 22 countries was 563.5 million. There were 29,771 firearm deaths in the US and 7,653 firearm deaths in the 22 other countries. Of all the firearm deaths in these 23 high-income countries in 2003, 80% occurred in the US. In the US the overall firearm death rate was 10.2 per 100,000, the overall firearm homicide rate 4.1 per 100,000, and the overall homicide rate 6.0 per 100,000, with firearm homicide rates highest persons 15 to 24 years of age. For the US the overall suicide rate was 10.8 per 100,000, and slightly over half of these deaths were firearm suicide (5.8 per 100,000). Firearm suicides rates increased with age. In the other high income countries 2003 the overall firearm death rate was 1.4 per 100,000, the overall firearm homicide rate 0.2 per 100,000, and the overall homicide rate 0.9 per 100,000. Firearm homicide rates were highest in the 25 year old to 34 year old age group. The overal suicide rate was 14.9 per 100,000 with a overall firearm suicide rate of 1.0 per 100,000.

80percent of all firearms deaths in 23 industrialized countries occurred in the US

A comparison across countries for an earlier time period is shown below.

Firearms Death Rate (per 100,000, age adjusted) for Selected Countries in one year between 1990 and 1995 (Krug, Powell and Dahlberg, 1998)

The number of firearms injuries remains high in the United States, compared with most of the rest of the world. Firearm suicide rates are strongly impacted by the rate of gun ownership. (Kaplan and Geling, 1998) There is a positive correlation between homicide rates and availability of guns in developed nations. (Hemenway and Miller, 2000) The number of firearms in the hands of private citizens continues to grow each year at a rate far exceeding that of the population as a whole. It might even be said that Americans live in a "gun culture" based upon traditions and behaviors well-entrenched in our society. This is reflected in our constitution, whose second amendment guarantees that "A well regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed." Though the application of this amendment applied to maintenance of a militia, and not private gun ownership, the second amendment has been consistently interpreted to protect private ownership of many types of guns.

Thus, the laws of our Federal government as well as the states do not as yet severely restrict the manufacture, sale, and use of firearms by ordinary citizens. "Gun control" is a sensitive issue that evokes strong emotions in persons both for and against control. Politicians find it difficult to deal with this issue. There is disagreement as to whether a reduction in access to or numbers of firearms will have a measurable effect upon crime. The Brady Handgun Violence Prevention Act passed in 1994 in the U.S. established a nationwide requirement that licensed firearms dealers observe a waiting period and initiate a background check for handgun sales (but the law does not apply to secondary markets). So far, this law has not been associated with overall reductions in homicide rate or suicide rate.(Ludwig and Cook, 2000) Perhaps our attitudes--and our tolerances--are reflected in the high visibility of firearms and firearms-inflicted injuries that are portrayed in the media: newspapers, magazines, books, films, and television. (Price et al, 1992) One thing remains certain, despite laws for or against gun control, a lack of care and concern regarding one's fellow human beings, whether in war or through domestic violence, will continue to promote firearms injuries.

Child safety is an important issue. Accidental shooting deaths are most commonly associated with one or more children playing with a gun they found in the home. (Choi, et al, 1994) The person pulling the trigger is a friend, family member, or the victim. (Harruff, 1992) In the period from 1979 to 2000, accidental firearms deaths involving children declined in the U.S., aided by child access prevention laws and felony prosecution of offenders. (Hepburn et al, 2006) A study of nonnatural deaths in a large American city revealed that half of such deaths in persons from 10 to 19 years of age were due to homicide, and firearms were involved in 88% of them. (Heninger and Hanzlick, 2008)

The table below indicates mode of death for firearms injuries in the ten countries with the most reported deaths from firearms for children less than 15 years of age. (CDC, 1997)

Firearms Deaths by Mode of Death for Children <15 Years of Age

Top 10 Countries - Rate per 100,000

In one survey, 10% of families admitted to having unlocked and loaded firearms within easy reach of children (Patterson and Smith, 1987). Another study showed that two-thirds of accidental firearms injuries occured in the home, and one-third involved children under 15. 45% were self-inflicted, and 16% occurred when children were playing with guns. (Morrow and Hudson, 1986) A study from 1991-2000 showed that twice as many people died from unintentional firearm injuries in states in the U.S. where firearm owners were more likely to store their firearms loaded. (Miller, et al, 2005)

The issue of "home defense" or protection against intruders or assailants may well be misrepresented. A study of 626 shootings in or around a residence in three U.S. cities revealed that, for every time a gun in the home was used in a self-defense or legally justifiable shooting, there were four unintentional shootings, seven criminal assaults or homicides, and 11 attempted or completed suicides (Kellermann et al, 1998). Over 50% of all households in the U.S. admit to having firearms (Nelson et al, 1987). In another study, regardless of storage practice, type of gun, or number of firearms in the home, having a gun in the home was associated with an increased risk of firearm homicide and suicide in the home (Dahlberg, Ikeda and Kresnow, 2004). Persons who own a gun and who engage in abuse of intimate partners such as a spouse are more likely to use a gun to threaten their intimate partner. (Rothman et al, 2005). Individuals in possession of a gun at the time of an assault are 4.46 times more likely to be shot in the assault than persons not in possession (Branas et al, 2009). It would appear that, rather than being used for defense, most of these weapons inflict injuries on the owners and their families.

Hunting accidents with firearms, despite the large gun ownership in the U.S. and numerous game seasons in most states, remain relatively rare and do not appear to be increasing. (Huiras, et al, 1990) In a study of accidental hunting firearm injuries and fatalities from 1961 to 1992 in Germany, there were 257 cases, most involving experienced hunters. 26% of the gunshot wounds were fatal. 23% of cases were self-inflicted and 77% injuries caused by another person. The firearms/ammunition included shotguns (63%) and shotgun slugs (3.5%), rifle bullets (31%), and handgun butllets (2.5%). 22% of pellet accidents produced severe eyeball injuries. 38% of the wounds occurred at a distance of 5 m or less, including all self-inflicted injuries. The most frequent factors responsible for the accident were: improper handling of the firearm (37%), failure to notice the victim (24.1%), covering the victim while swinging on the game (14.8%), ricocheting projectiles (13.6%), inadequate storage of the firearm (11.7%) and mistaking the victim for game (9.3%). (Karger et al, 1996)

 Proceed to History of Firearms.


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