[Physician Comment] A look back at a 2002 study: Firearm availability associated with higher rates of unintended death in children
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Image: PD
1. Firearm-related injury to children is associated with severe morbidity or death and is a major public health issue.
2. In regions where guns were more prevalent, a disproportionately high number of 5–14 year olds died from suicide, homicide, and unintentional firearm deaths.
Given the disproportionately higher level of overall lethal violence where guns are more available, the implication is that violence is more likely to turn lethal where there are more guns.
The study’s clear limitation, addressed quite frankly by the authors, is the use of derived measures of firearm availability as proxies, although the derived measures were highly correlated with the direct measures of gun ownership rates. And, as a cross-sectional study, conclusions of causality unfortunately cannot be drawn. Nonetheless, since all proxy measurements are significantly related to the rate of gun-homicide and overall homicide, but not to the rate of non-gun homicide, firearm availability likely plays a causal role in homicide rates among children.
Physicians should be aware that firearm availability places children at risk for lethal injury and is an important cause of mortality among children and adolescents. As advocates for patient protection and well being, health care professionals working with pediatric populations should include gun safety education in their interactions with patients and families, incorporating questions about the presence and availability of firearms in the home environment, and the dangers associated with this presence.
Please click to read study in The Journal of Trauma
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Study author, Dr. Matt Miller, talks to 2 Minute Medicine: Associate Professor of Health Policy and Management, Harvard University, Boston, MA
“Among developed nations, the United States has the highest rate of civilian gun ownership, the most permissive gun control laws, and the highest homicide rate. This is most striking for children and young adults.
Within the US, the same pattern can be seen after adjusting for underlying rates of overall violent victimization: places with higher rates of household firearm ownership have higher rates of homicide, especially for women and children. The analyses with respect to the latter are presented in [this] paper.”
Image: PD
1. Firearm-related injury to children is associated with severe morbidity or death and is a major public health issue.
2. In regions where guns were more prevalent, a disproportionately high number of 5–14 year olds died from suicide, homicide, and unintentional firearm deaths.
Primer: In the wake of the tragedy that recently took place at Sandy Hook Elementary School in Newton, Connecticut, we present a 2002 paper that attempts to establish a relationship between firearm prevalence and unintentional firearm death, suicide, and homicide in the pediatric population. Firearm-related deaths continually define one of the top three causes of mortality among the youth in the United States, in both urban and rural areas. As of 2004, it is estimated that approximately 38% of all households own at least 1 gun, of which 40% are handguns. Motivation for ownership is primarily recreational, although self-protection is almost unanimously cited. Guns stored in home have been associated with a three-fold increase in homicide risk and a five-fold increase in suicide risk. This nation-wide study from 2002 expands on previous findings and is one of the first to focus its breadth and scope on a particular population – children aged 5 to 14.
For further reading, please see the following studies:
- Zavoski, RW, Lapidus GD, Lerer TJ, et al. A population-based study of severe firearm injury among children and youth. Pediatrics 1995;96(2):278-282.
- Richardson EG, Hemenway D. Homicide, suicide, and unintentional firearm fatality: Comparing the United States with other high-income countries, 2003. The Journal of Trauma 2011;70(1):238-243.
This [cross-sectional] study: Time-series data from the 50 states between 1988 and 1997 was collected using four measures of firearm availability. Two measures of firearm availability came from published survey-based estimates of household firearm ownership (i.e., at the regional and state levels), while two were derived measures (supported in alternative studies). Multivariable analyses adjusted for other independent variables associated with violent death: poverty, education, and urbanization.
During this 10-year study, it was found that 6,817 children between the ages of 5 and 14 years were killed with firearms in the United States, with approximately 50% being homicides, 25% suicides, and 25% unintended deaths. Each of the four proxy measurements led to the same conclusion: there was a significant positive association between firearm availability and firearm death in this age group at both the state and regional level, and even after controlling for the aforementioned variables associated with firearm violence.
In sum: Given the disproportionately higher level of overall lethal violence where guns are more available, the implication is that violence is more likely to turn lethal where there are more guns.
The study’s clear limitation, addressed quite frankly by the authors, is the use of derived measures of firearm availability as proxies, although the derived measures were highly correlated with the direct measures of gun ownership rates. And, as a cross-sectional study, conclusions of causality unfortunately cannot be drawn. Nonetheless, since all proxy measurements are significantly related to the rate of gun-homicide and overall homicide, but not to the rate of non-gun homicide, firearm availability likely plays a causal role in homicide rates among children.
Physicians should be aware that firearm availability places children at risk for lethal injury and is an important cause of mortality among children and adolescents. As advocates for patient protection and well being, health care professionals working with pediatric populations should include gun safety education in their interactions with patients and families, incorporating questions about the presence and availability of firearms in the home environment, and the dangers associated with this presence.
Please click to read study in The Journal of Trauma
Written by [JDP] and [AC]
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Joseph Del Paggio: Originally from Thunder Bay, ON, where he received his degrees in both Honours Biology and Education, Joseph Del Paggio is currently a 4th year of M.D. candidate at the University of Ottawa. Over his medical undergraduate studies, he has gained a deep respect for the ever-expansive and diagnostically-challenging field of Internal Medicine. That said, one of his loves is live music. Although he tries (and fails) to imitate the man on guitar, he’d rather be at a Neil Young concert.
Andrew Cheung: Andrew is currently a 4th year M.D. candidate at the University of Ottawa in Canada. He is an avid basketball fan, and is interested in pursuing a career in internal medicine. Andrew is responsible for editing, writing and leading the direction of the ICU, pulmonology and medicine content. His hometown is Mississauga, Ontario, Canada.
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