Global Mortality From Firearms, 1990-2016
Authors: 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, Alireza Esteghamati, Andre Faro, Farshad Farzadfar, Valery L. Feigin, Florian Fischer, Kyle J. Foreman, Richard Charles Franklin, Nancy Fullman, Neal D. Futran, Tsegaye Tewelde Gebrehiwot, Reyna Alma Gutiérrez, Nima Hafezi-Nejad, Hassan Haghparast Bidgoli, Gessessew Bugssa Hailu, Josep Maria Haro, Hamid Yimam Hassen, Caitlin Hawley, Delia Hendrie, Martha Híjar, Guoqing Hu, Olayinka Stephen Ilesanmi, Mihajlo Jakovljevic, Spencer L. James, Sudha Jayaraman, Jost B. Jonas, Amaha Kahsay, Amir Kasaeian, Peter Njenga Keiyoro, Yousef Khader, Ibrahim A. Khalil, Young-Ho Khang, Jagdish Khubchandani, Aliasghar Ahmad Kiadaliri, Christian Kieling, Yun Jin Kim, Soewarta Kosen, Kristopher J. Krohn, G. Anil Kumar, Faris Hasan Lami, Van C. Lansingh, Heidi Jane Larson, Shai Linn, Raimundas Lunevicius, Hassan Magdy Abd El Razek, Muhammed Magdy Abd El Razek, Reza Malekzadeh, Deborah Carvalho Malta, Amanda J. Mason-Jones, Richard Matzopoulos, Peter T. N. Memiah, Walter Mendoza, Tuomo J. Meretoja, Haftay Berhane Mezgebe, Ted R. Miller, Shafiu Mohammed, Maziar Moradi-Lakeh, Rintaro Mori, Devina Nand, Cuong Tat Nguyen, Quyen Le Nguyen, Dina Nur Anggraini Ningrum, Felix Akpojene Ogbo, Andrew T. Olagunju, George C. Patton, Michael R. Phillips, Suzanne Polinder, Farshad Pourmalek, Mostafa Qorbani, Afarin Rahimi-Movaghar, Vafa Rahimi-Movaghar, Mahfuzar Rahman, Rajesh Kumar Rai, Chhabi Lal Ranabhat, David Laith Rawaf, Salman Rawaf, Ali Rowhani-Rahbar, Mahdi Safdarian, Saeid Safiri, Rajesh Sagar, Joseph S. Salama, Juan Sanabria, Milena M. Santric Milicevic, Rodrigo Sarmiento-Suárez, Benn Sartorius, Maheswar Satpathy, David C. Schwebel, Soraya Seedat, Sadaf G. Sepanlou, Masood Ali Shaikh, Nigussie Tadesse Sharew, Ivy Shiue, Jasvinder A. Singh, Mekonnen Sisay, Vegard Skirbekk, Adauto Martins Soares Filho, Dan J. Stein, Mark Andrew Stokes, Mu’awiyyah Babale Sufiyan, Mamta Swaroop, Bryan L. Sykes, Rafael Tabarés-Seisdedos, Fentaw Tadese, Bach Xuan Tran, Tung Thanh Tran, Kingsley Nnanna Ukwaja, Tommi Juhani Vasankari, Vasily Vlassov, Andrea Werdecker, Pengpeng Ye, Paul Yip, Naohiro Yonemoto, Mustafa Z. Younis, Zoubida Zaidi, Maysaa El Sayed Zaki, Simon I. Hay, Stephen S. Lim, Alan D. Lopez, Ali H. Mokdad, Theo Vos, Christopher J. L. Murray
Journal: JAMA (2018)

<h3>Importance</h3> Understanding global variation in firearm mortality rates could guide prevention policies and interventions. <h3>Objective</h3> To estimate mortality due to firearm injury deaths from 1990 to 2016 in 195 countries and territories. <h3>Design, Setting, and Participants</h3> 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. <h3>Exposures</h3> Firearm ownership and access. <h3>Main Outcomes and Measures</h3> Cause-specific deaths by age, sex, location, and year. <h3>Results</h3> 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 (<i>P</i> &lt; .001;<i>R2</i> = 0.21) and homicide (<i>P</i> &lt; .001;<i>R2</i> = 0.35). <h3>Conclusions and Relevance</h3> 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.