The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #70736

Charles Branas, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania, Room 829 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, 215.573.5381, cbranas@cceb.med.upenn.edu, Michael L. Nance, MD, Department of Surgery, Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104, Michael R. Elliott, PhD, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 612 Blockley Hall/6021, 423 Guardian Drive, Philadelphia, PA 19104, Therese S. Richmond, PhD, School of Nursing, University of Pennsylvania, Nursing Education Building, 412, Philadelphia, PA 19104-6096, and C. William Schwab, MD, Firearm Injury Center at Penn, University of Pennsylvania, 3440 Market Street, First Floor, Philadelphia, PA 19104-3335.

Purpose: Firearm death in the U.S. is perceived as a principally urban, principally criminal phenomenon. We explored this perception by analyzing all intentionally inflicted U.S. firearm deaths with a new, detailed county categorization scheme. Methods: Vital statistics data were accessed for all homicides and suicides occurring in the U.S. from 1989-1999. Decedents were assigned to 3,141 counties and analyzed as per a modified rural-urban continuum code assigned per county per year. This code distinguished counties into 11 categories by population size and relationship to metropolitan areas. Time-series regressions were used to adjust for other social, demographic, and economic variables. Results: Among 584,629 decedents reviewed, 34.2% were firearm suicides, 28.7% firearm homicides, 23.4% nonfirearm suicides, and 11.1% nonfirearm homicides. The most urban counties had 1.00 (95% CI, 0.85 to 1.17) times the average adjusted firearm death rate of the most rural (p=0.983). The most rural counties experienced 1.33 (95% CI, 1.17 to 1.53] times the average adjusted firearm suicide rate of the most urban (p<0.001). The most urban counties experienced 2.05 (95% CI, 1.63 to 2.58) times the average adjusted firearm homicide rate of the most rural (p<0.001). These opposing trends were not present for nonfirearm suicide and nonfirearm homicide. Conclusions: The risk of firearm mortality consistently affects both urban and rural counties in the U.S. Firearm suicide in rural counties is as important a public health problem as firearm homicide in urban counties. Heightened awareness that firearm death can occur in all types of communities in the U.S. is needed.

Learning Objectives:

Participants will be able to:
• Distinguish the differences between urban and rural risks of firearm death.
• Articulate the criminal and noncriminal distinctions between firearm death types.
• Recognize the need to broaden the public's awareness that firearm death can occur in all types of communities in the United States.

Keywords: Firearms, Injury Risk

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.