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Fridel EE, Zimmerman GM, Arrigo SR. Examining the Impact of Minimum Handgun Purchase Age and Background Check Legislation on Young Adult Suicide in the United States, 1991-2020. Am J Public Health 2024; 114:805-813. [PMID: 38870430 PMCID: PMC11224627 DOI: 10.2105/ajph.2024.307689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2024] [Indexed: 06/15/2024]
Abstract
Objectives. To examine the independent and joint effects of state legislation on minimum age for purchasing handguns and background checks on the suicide of young adults aged 18 to 20 years. Methods. We used negative binomial regressions with fixed effects for year and generalized estimating equations for state to estimate the effects of state legislation on annual counts of firearm, nonfirearm, and total young adult suicides in all 50 US states from 1991 to 2020. Results. Minimum age laws decreased the incidence rate of firearm suicide among young adults, an effect that was amplified in states with permit to purchase laws; there was no effect on the nonfirearm or total suicide rate. Permit to purchase laws significantly decreased the young adult firearm suicide incidence rate by 39% (incidence rate ratio [IRR] = 0.61; 95% confidence interval [CI] = 0.51, 0.74) and the overall suicide incidence rate by 14% (IRR = 0.86; 95% CI = 0.75, 0.99), with no effect on the nonfirearm suicide rate. Conclusions. Permit to purchase laws are a more promising avenue for reducing young adult suicides than are age-based restrictions. (Am J Public Health. 2024;114(8):805-813. https://doi.org/10.2105/AJPH.2024.307689).
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Affiliation(s)
- Emma E Fridel
- Emma E. Fridel and Shayna R. Arrigo are with the College of Criminology and Criminal Justice, Florida State University, Tallahassee. Gregory M. Zimmerman is with the School of Criminology and Criminal Justice, Northeastern University, Boston, MA
| | - Gregory M Zimmerman
- Emma E. Fridel and Shayna R. Arrigo are with the College of Criminology and Criminal Justice, Florida State University, Tallahassee. Gregory M. Zimmerman is with the School of Criminology and Criminal Justice, Northeastern University, Boston, MA
| | - Shayna R Arrigo
- Emma E. Fridel and Shayna R. Arrigo are with the College of Criminology and Criminal Justice, Florida State University, Tallahassee. Gregory M. Zimmerman is with the School of Criminology and Criminal Justice, Northeastern University, Boston, MA
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Keyes KM, Kandula S, Martinez-Ales G, Gimbrone C, Joseph V, Monnat S, Rutherford C, Olfson M, Gould M, Shaman J. Geographic Variation, Economic Activity, and Labor Market Characteristics in Trajectories of Suicide in the United States, 2008-2020. Am J Epidemiol 2024; 193:256-266. [PMID: 37846128 DOI: 10.1093/aje/kwad205] [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: 05/05/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
Suicide rates in the United States have increased over the past 15 years, with substantial geographic variation in these increases; yet there have been few attempts to cluster counties by the magnitude of suicide rate changes according to intercept and slope or to identify the economic precursors of increases. We used vital statistics data and growth mixture models to identify clusters of counties by their magnitude of suicide growth from 2008 to 2020 and examined associations with county economic and labor indices. Our models identified 5 clusters, each differentiated by intercept and slope magnitude, with the highest-rate cluster (4% of counties) being observed mainly in sparsely populated areas in the West and Alaska, starting the time series at 25.4 suicides per 100,000 population, and exhibiting the steepest increase in slope (0.69/100,000/year). There was no cluster for which the suicide rate was stable or declining. Counties in the highest-rate cluster were more likely to have agricultural and service economies and less likely to have urban professional economies. Given the increased burden of suicide, with no clusters of counties improving over time, additional policy and prevention efforts are needed, particularly targeted at rural areas in the West.
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Degli Esposti M, Goldstick J, Gravel J, Kaufman EJ, Delgado MK, Richmond TS, Wiebe DJ. How have firearm laws changed in states with unexpected decreases or increases in firearm homicide, 1990-2019? SSM Popul Health 2023; 22:101364. [PMID: 36941896 PMCID: PMC10024039 DOI: 10.1016/j.ssmph.2023.101364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Background Firearm violence is one of the leading preventable causes of death and injury in the United States and is on the rise. While policies regulating access to firearms offer opportunities to prevent firearm-related deaths, an understanding of the holistic impact of changing state firearm policies on firearm homicide rates over the last 30 years is limited. Objectives To identify US states that showed unexpected decreases and increases in firearm homicide rates and summarise their firearm policy changes in the last three decades. Methods We analysed changes in firearm homicide rates by US state and county from 1990 to 2019. We triangulated across three estimation approaches to derive state rankings and identify the top and bottom three states which consistently showed unexpected decreases (low outliers) and increases (high outliers) in firearm homicide rates. We summarised firearm policy changes in state outliers using the RAND State Firearm Law Database. Results We identified New York, District of Columbia, and Hawaii as low state outliers and Delaware, New Jersey, and Missouri as high state outliers. Low state outliers made more restrictive firearm policy changes than high state outliers, which covered a wider range of policy types. Restrictive changes in high state outliers primarily targeted high-risk populations (e.g., prohibited possessors, safe storage). Specific legislative details, such as the age threshold (18 vs 21 years old) for firearm minimum age requirements, also emerged as important for differentiating low from high state outliers. Conclusions While no firearm law change emerged as necessary or sufficient, an accumulation of diverse restrictive firearm policies may be key to alleviating the death toll from firearm homicide.
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Affiliation(s)
- Michelle Degli Esposti
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, USA
- University of Michigan Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, USA
- Corresponding author.
| | - Jason Goldstick
- Injury Prevention Center, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, USA
- University of Michigan Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, USA
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, USA
| | - Jason Gravel
- Department of Criminal Justice, Temple University, Philadelphia, PA, USA
| | - Elinore J. Kaufman
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, USA
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - M. Kit Delgado
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, USA
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
- Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Therese S. Richmond
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, USA
- Biobehavioral Health Sciences Department, University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Douglas J. Wiebe
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, USA
- Injury Prevention Center, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, USA
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
- University of Michigan Institute for Firearm Injury Prevention, University of Michigan, Ann Arbor, USA
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Gaffney A, Himmelstein DU, Dickman S, Myers C, Hemenway D, McCormick D, Woolhandler S. Projected Health Outcomes Associated With 3 US Supreme Court Decisions in 2022 on COVID-19 Workplace Protections, Handgun-Carry Restrictions, and Abortion Rights. JAMA Netw Open 2023; 6:e2315578. [PMID: 37289459 PMCID: PMC10251209 DOI: 10.1001/jamanetworkopen.2023.15578] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/12/2023] [Indexed: 06/09/2023] Open
Abstract
Importance Several recent US Supreme Court rulings have drawn criticism from the medical community, but their health consequences have not been quantitatively evaluated. Objective To model health outcomes associated with 3 Supreme Court rulings in 2022 that invalidated workplace COVID-19 vaccine or mask-and-test requirements, voided state handgun-carry restrictions, and revoked the constitutional right to abortion. Design, Setting, and Participants This decision analytical modeling study estimated outcomes associated with 3 Supreme Court rulings in 2022: (1) National Federation of Independent Business v Department of Labor, Occupational Safety and Health Administration (OSHA), which invalidated COVID-19 workplace protections; (2) New York State Rifle and Pistol Association Inc v Bruen, Superintendent of New York State Police (Bruen), which voided state laws restricting handgun carry; and (3) Dobbs v Jackson Women's Health Organization (Dobbs), which revoked the constitutional right to abortion. Data analysis was performed from July 1, 2022, to April 7, 2023. Main Outcomes and Measures For the OSHA ruling, multiple data sources were used to calculate deaths attributable to COVID-19 among unvaccinated workers from January 4 to May 28, 2022, and the share of these deaths that would have been prevented by the voided protections. To model the Bruen decision, published estimates of the consequences of right-to-carry laws were applied to 2020 firearm-related deaths (and injuries) in 7 affected jurisdictions. For the Dobbs ruling, the model assessed unwanted pregnancy continuations, resulting from the change in distance to the closest abortion facility, and then excess deaths (and peripartum complications) from forcing these unwanted pregnancies to term. Results The decision model projected that the OSHA decision was associated with 1402 additional COVID-19 deaths (and 22 830 hospitalizations) in early 2022. In addition, the model projected that 152 additional firearm-related deaths (and 377 nonfatal injuries) annually will result from the Bruen decision. Finally, the model projected that 30 440 fewer abortions will occur annually due to current abortion bans stemming from Dobbs, with 76 612 fewer abortions if states at high risk for such bans also were to ban the procedure; these bans will be associated with an estimated 6 to 15 additional pregnancy-related deaths each year, respectively, and hundreds of additional cases of peripartum morbidity. Conclusions and Relevance These findings suggest that outcomes from 3 Supreme Court decisions in 2022 could lead to substantial harms to public health, including nearly 3000 excess deaths (and possibly many more) over a decade.
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Affiliation(s)
- Adam Gaffney
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts
| | - David U. Himmelstein
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts
- Hunter College, City University of New York, New York, New York
- Public Citizen Health Research Group, Washington, DC
| | | | | | - David Hemenway
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Danny McCormick
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Steffie Woolhandler
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts
- Hunter College, City University of New York, New York, New York
- Public Citizen Health Research Group, Washington, DC
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Barry LE, Crealey GE, Nguyen NTQ, Weiser TG, Spitzer SA, O’Neill C. Hospital Costs and Fatality Rates of Traumatic Assaults by Mechanism in the US, 2016-2018. JAMA Netw Open 2022; 5:e2218496. [PMID: 35749116 PMCID: PMC9233231 DOI: 10.1001/jamanetworkopen.2022.18496] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Estimates of the total economic cost of firearm violence are important in drawing attention to this public health issue; however, studies that consider violence more broadly are needed to further the understanding of the extent to which such costs can be avoided. OBJECTIVES To estimate the association of firearm assaults with US hospital costs and deaths compared with other assault types. DESIGN, SETTING, AND PARTICIPANTS The 2016-2018 US Nationwide Emergency Department Sample and National Inpatient Sample, Healthcare Cost and Utilization Project were used in this cross-sectional study of emergency department (ED) and inpatient admissions for assaults involving a firearm, sharp object, blunt object, or bodily force identified using International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes. Differences in ED and inpatient costs (2020 US dollars) across mechanisms were estimated using ordinary least-squares regression with and without adjustments for year and hospital, patient, and injury characteristics. The Centers for Disease Control and Prevention underlying cause of death data were used to estimate national death rates and hospital case-fatality rates across mechanisms. Cost analysis used a weighted sample. National death rates and hospital case-fatality rates used US resident death certificates, covering 976 million person-years. Hospital case-fatality rates also used nationally weighted ED records covering 2.7 million admissions. Data analysis was conducted from March 1, 2021, to March 31, 2022. EXPOSURE The primary exposure was the mechanism used in the assault. MAIN OUTCOMES AND MEASURES Emergency department and inpatient costs per record. National death rates and hospital case-fatality rates. RESULTS Overall, 2.4 million ED visits and 184 040 inpatient admissions for assault were included. Across all mechanisms, the mean age of the population was 32.7 (95% CI, 32.6-32.9) years in the ED and 36.4 (95% CI, 36.2-36.7) years in the inpatient setting; 41.9% (95% CI, 41.2%-42.5%) were female in the ED, and 19.1% (95% CI, 18.6%-19.6%) of inpatients were female. Most assaults recorded in the ED involved publicly insured or uninsured patients and hospitals in the Southern US. Emergency department costs were $678 (95% CI, $657-$699) for bodily force, $861 (95% CI, $813-$910) for blunt object, $996 (95% CI, $925-$1067) for sharp object, and $1388 (95% CI, $1254-$1522) for firearm assaults. Corresponding inpatient costs were $14 702 (95% CI, $14 178-$15 227) for bodily force, $17 906 (95% CI, $16 888-$18 923) for blunt object, $19 265 (95% CI, $18 475-$20 055) for sharp object, and $34 949 (95% CI, $33 654-$36 244) for firearm assaults. National death rates per 100 000 were 0.04 (95% CI, 0.03-0.04) for bodily force, 0.03 (95% CI, 0.03-0.03) for blunt object, 0.54 (95% CI, 0.52-0.55) for sharp object, and 4.40 (95% CI, 4.36-4.44) for firearm assaults. Hospital case fatality rates were 0.01% (95% CI, 0.009%-0.012%) for bodily force, 0.05% (95% CI, 0.04%-0.06%) for blunt object, 1.05% (95% CI, 1.00%-1.09%) for sharp object, and 15.26% (95% CI, 15.04%-15.49%) for firearm assaults. In regression analysis, ED costs for firearm assaults were 59% to 99% higher than costs for nonfirearm assaults, and inpatient costs were 67% to 118% higher. CONCLUSIONS AND RELEVANCE The findings of this study suggest that it may be useful for policies aimed at reducing the costs of firearm violence to consider violence more broadly to understand the extent to which costs can be avoided.
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Affiliation(s)
- Luke E. Barry
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Grainne E. Crealey
- John E. Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland
| | - Nga T. Q. Nguyen
- Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Thomas G. Weiser
- Department of Surgery, Stanford University, Stanford, California
| | | | - Ciaran O’Neill
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
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Castillo CM, Chang RG, Glassman SJ, Jones G, Venkatachalam AM, Williams T, Ifejika NL. Advocacy for the prevention and reduction of firearm-related injuries. PM R 2021; 13:1291-1295. [PMID: 34415109 DOI: 10.1002/pmrj.12696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/27/2021] [Accepted: 08/06/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Camilo M Castillo
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Richard G Chang
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stuart J Glassman
- Granite Physiatry, Concord, New Hampshire, USA.,Department of Orthopedics/Division of Physical Medicine and Rehabilitation, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Gaberiel Jones
- Department of Health Promotion and Behavioral Sciences, University of Louisville School of Public Health & Information Sciences, Louisville, Kentucky, USA
| | | | - Terrell Williams
- Youth Violence Prevention Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Nneka L Ifejika
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, USA.,Department of Neurology, UT Southwestern Medical Center, Dallas, Texas, USA.,Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas, USA
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