Trends in firearm-related hospitalizations and deaths in New Zealand

1. In this retrospective cohort study, firearm-related deaths in New Zealand were found to have decreased over time and were most commonly due to suicide.

2. Conversely, firearm-related hospitalizations were most commonly due to accidental injuries, with males, Māori, and lower-income individuals being more likely to be hospitalized.

Evidence Rating Level: 2 (Good)

Study Rundown: It is estimated that in 2018, there were more than one million firearms held among gun license holders in New Zealand (NZ). Studies on firearm-related mortality in NZ have largely focused on specific situations, including suicide and gun crime. This study aimed to evaluate the population- and individual-level risks for firearm-related hospitalizations and deaths in NZ as well as the costs associated with firearm hospitalizations. Combined firearm-related homicide and suicide rates were found to have decreased by about two-thirds in the past two to three decades. However, individual-level data showed over one thousand firearm-related deaths since the start of the century, with the most common cause of death being suicide. Mortality was highest among adult males and individuals identifying as European/Other. Among Māori individuals, suicide rates were lower but assault rates were higher compared with European/Other individuals. There were over two thousand firearm-related hospitalizations in the same time period, with accidental injuries being most common. Hospitalizations due to accidental injuries decreased, but hospitalizations due to assault increased. Again, males and Māori individuals had the highest rates among the population. These incidents were associated with significant costs, with over two thousand years of life lost annually as well as annual total mortality costs of nearly two hundred million dollars. The generalizability of this study is limited by a lack of data on firearm injuries not leading to hospitalization or death. Nevertheless, these findings underscore the frequency and costs of firearm-related harm in New Zealand.

Click to read this study in AIM

Relevant Reading: Australia’s 1996 gun law reforms: faster falls in firearm deaths, firearm suicides, and a decade without mass shootings

In-Depth [retrospective cohort]: This study aimed to assess the population- and individual-level risks for firearm-related deaths and hospitalizations in NZ. Population-level data were obtained from 1980 through 2020, while individual-level hospitalization and mortality data were obtained from 2000 through 2018. Combined firearm-related homicide and suicide rates decreased from 31.0 deaths per million people in 1992 to 9.4 deaths per million people in 2018. From 2000 through 2018, 1050 firearm-related deaths were identified, for an average annual mortality rate of 13.14 deaths per million. The most common causes were suicide (n = 819), assaults (n = 147), and accidental deaths (n = 48). Age-standardized rates were highest among adults (16.35 deaths per million) and lowest among children under 18 years of age (2.32 per million). Deaths were mostly among males, who had a mortality rate of 24.12 per million people, while females had a mortality rate of 2.27 per million people. Māori had a lower risk for self-harm deaths (RR, 0.59 [95% CI, 0.46 to 0.77]) but a higher risk for assault deaths (RR, 3.11 [95% CI, 2.16 to 4.48]) compared with European/Other individuals. From 2000 through 2018, 2115 hospitalizations occurred relating to firearms, with the most common cause being accidental injuries (n = 1266). Firearm-related hospitalization rates were 10-fold higher for males than for females during this period; they were higher for Māori individuals (50 to 67 per million) compared with European/White individuals (19 to 30 per million) from 2015 through 2018. Age-standardized rates were highest among adults (41.40 per million) and lowest among children aged 18 or younger (26.28 per million). Children aged 0-14 years had a lower risk of hospitalization due to self-harm (RR, 0.10 [95% CI, 0.04 to 0.25]) or assault (RR, 0.17 [95% CI, 0.12 to 0.26]) compared with those aged 15 years or older, although they had a higher risk of hospitalization due to accidents (RR, 1.11 [95% CI, 0.97 to 1.27]). Firearm-related hospitalizations were lowest among the wealthiest quintile (14.56 per million) and highest among the lowest-income quintile (35.45 per million), with risk of hospitalization increasing with each lower-income quintile (RR, 1.69 [95% CI, 1.24 to 2.30]). Annually, years of life lost averaged 2139.7 between 2000 and 2018, corresponding to a total mortality cost of $189 million per year. The average annual cost of firearm-related hospitalizations was $871,000 ($6358 per injury), for a total cost of $16.8 million between 2000 and 2018. Overall, this study suggests that although firearm-related deaths have decreased, hospitalizations remain high especially in certain subpopulations and continue to incur significant costs.

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