Global mortality from firearms, 1990-2016

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; Felix 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-Lakey; Rintaro Mori; Devina Nand; Cuong Tat Nguyen; Quyen Le Nguyen; Dina Nur Anggraini Mingrum; Felix Akpojene Ogbo; null et al

doi:10.1001/jama.2018.10060

Global mortality from firearms, 1990-2016

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 QuintanillaSuzanne 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, Felix 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-Lakey, Rintaro Mori, Devina Nand, Cuong Tat Nguyen, Quyen Le Nguyen, Dina Nur Anggraini Mingrum, Felix Akpojene Ogbo, et al

Western Sydney University

Research output: Contribution to journal › Article › peer-review

229 Citations (Scopus)

Abstract

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

Original language	English
Pages (from-to)	792-814
Number of pages	23
Journal	JAMA
Volume	320
Issue number	8
DOIs	https://doi.org/10.1001/jama.2018.10060
Publication status	Published - 2018

Keywords

firearms accidents
mortality

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1001/jama.2018.10060

Cite this

Naghavi, M., Marczak, L. B., Kutz, M., Shackelford, K. A., Arora, M., Miller-Petrie, M., Aichour, M. T. E., Akseer, N., Al-Raddadi, R. M., Alam, K., Alghnam, S. A., Antonio, C. A. T., Aremu, O., Arora, A., Asadi-Lari, M., Assadi, R., Atey, T. M., Avila-Burgos, L., Awasthi, A., ... et al (2018). Global mortality from firearms, 1990-2016. JAMA, 320(8), 792-814. https://doi.org/10.1001/jama.2018.10060

@article{f8ba29ed54384c4ea80326800bcee89d,

title = "Global mortality from firearms, 1990-2016",

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

keywords = "firearms accidents, mortality",

author = "Mohsen Naghavi and Marczak, {Laurie B.} and Michael Kutz and Shackelford, {Katya Anne} and Megha Arora and Molly Miller-Petrie and Aichour, {Miloud Taki Eddine} and Nadia Akseer and Al-Raddadi, {Rajaa M.} and Khurshid Alam and Alghnam, {Suliman A.} and Antonio, {Carl Abelardo T.} and Olatunde Aremu and Amit Arora and Mohsen Asadi-Lari and Reza Assadi and Atey, {Tesfay Mehari} and Leticia Avila-Burgos and Ashish Awasthi and Quintanilla, {Beatriz Paulina Ayala} and Barker-Collo, {Suzanne Lyn} and B{\"a}rnighausen, {Till Winfried} and Shahrzad Bazargan-Hejazi and Masoud Behzadifar and Meysam Behzadifar and Bennett, {James R.} and Ashish Bhalla and Bhutta, {Zulfiqar A.} and Bilal, {Arebu Issa} and Guilherme Borges and Rohan Borschmann and Alexandra Brazinova and Rincon, {Julio Cesar Campuzano} and Felix Carvalho and Casta{\~n}eda-Orjuela, {Carlos A.} and Lalit Dandona and Rakhi Dandona and Dargan, {Paul I.} and {De Leo}, Diego and Dharmaratne, {Samath Dhamminda} and Ding, {Eric L.} and Do, {Huyen Phuc} and Doku, {David Teye} and Doyle, {Kerrie E.} and Driscoll, {Tim Robert} and Dumessa Edessa and Ziad El-Khatib and Endries, {Aman Yesuf} and Alireza Esteghamati and Andre Faro and Farshad Farzadfar and Feigin, {Valery L.} and Florian Fischer and Foreman, {Kyle J.} and Franklin, {Richard Charles} and Nancy Fullman and Futran, {Neal D.} and Gebrehiwot, {Tsegaye Tewelde} and Guti{\'e}rrez, {Reyna Alma} and Nima Hafezi-Nejad and Bidgoli, {Hassan Haghparast} and Hailu, {Gessessew Bugssa} and Haro, {Josep Maria} and Hassen, {Hamid Yimam} and Caitlin Hawley and Delia Hendrie and Martha H{\'i}jar and Guoqing Hu and Ilesanmi, {Olayinka Stephen} and Mihajlo Jakovljevic and James, {Spencer L.} and Sudha Jayaraman and Jonas, {Jost B.} and Amaha Kahsay and Amir Kasaeian and Keiyoro, {Peter Njenga} and Yousef Khader and Khalil, {Ibrahim A.} and Young-Ho Khang and Jagdish Khubchandani and Kiadaliri, {Aliasghar Ahmad} and Christian Kieling and Kim, {Yun Jin} and Soewarta Kosen and Krohn, {Kristopher J.} and Kumar, {G. Anil} and Lami, {Faris Hasan} and Lansingh, {Van C.} and Larson, {Heidi Jane} and Shai Linn and Raimundas Lunevicius and {Abd El Razek}, {Hassan Magdy} and {Abd El Razek}, {Muhammed Magdy} and Reza Malekzadeh and Malta, {Deborah Carvalho} and Mason-Jones, {Amanda J.} and Richard Matzopoulos and Memiah, {Peter T. N.} and Walter Mendoza and Meretoja, {Tuomo J.} and Mezgebe, {Haftay Berhane} and Miller, {Ted R.} and Shafiu Mohammed and Maziar Moradi-Lakey and Rintaro Mori and Devina Nand and Nguyen, {Cuong Tat} and Nguyen, {Quyen Le} and Mingrum, {Dina Nur Anggraini} and Ogbo, {Felix Akpojene} and {et al}",

year = "2018",

doi = "10.1001/jama.2018.10060",

language = "English",

volume = "320",

pages = "792--814",

journal = "JAMA",

issn = "0098-7484",

publisher = "American Medical Association",

number = "8",

}

Naghavi, M, Marczak, LB, Kutz, M, Shackelford, KA, Arora, M, Miller-Petrie, M, Aichour, MTE, Akseer, N, Al-Raddadi, RM, Alam, K, Alghnam, SA, Antonio, CAT, Aremu, O, Arora, A, Asadi-Lari, M, Assadi, R, Atey, TM, Avila-Burgos, L, Awasthi, A, Quintanilla, BPA, Barker-Collo, SL, Bärnighausen, TW, Bazargan-Hejazi, S, Behzadifar, M, Behzadifar, M, Bennett, JR, Bhalla, A, Bhutta, ZA, Bilal, AI, Borges, G, Borschmann, R, Brazinova, A, Rincon, JCC, Carvalho, F, Castañeda-Orjuela, CA, Dandona, L, Dandona, R, Dargan, PI, De Leo, D, Dharmaratne, SD, Ding, EL, Do, HP, Doku, DT, Doyle, KE, Driscoll, TR, Edessa, D, El-Khatib, Z, Endries, AY, Esteghamati, A, Faro, A, Farzadfar, F, Feigin, VL, Fischer, F, Foreman, KJ, Franklin, RC, Fullman, N, Futran, ND, Gebrehiwot, TT, Gutiérrez, RA, Hafezi-Nejad, N, Bidgoli, HH, Hailu, GB, Haro, JM, Hassen, HY, Hawley, C, Hendrie, D, Híjar, M, Hu, G, Ilesanmi, OS, Jakovljevic, M, James, SL, Jayaraman, S, Jonas, JB, Kahsay, A, Kasaeian, A, Keiyoro, PN, Khader, Y, Khalil, IA, Khang, Y-H, Khubchandani, J, Kiadaliri, AA, Kieling, C, Kim, YJ, Kosen, S, Krohn, KJ, Kumar, GA, Lami, FH, Lansingh, VC, Larson, HJ, Linn, S, Lunevicius, R, Abd El Razek, HM, Abd El Razek, MM, Malekzadeh, R, Malta, DC, Mason-Jones, AJ, Matzopoulos, R, Memiah, PTN, Mendoza, W, Meretoja, TJ, Mezgebe, HB, Miller, TR, Mohammed, S, Moradi-Lakey, M, Mori, R, Nand, D, Nguyen, CT, Nguyen, QL, Mingrum, DNA, Ogbo, FA & et al 2018, 'Global mortality from firearms, 1990-2016', JAMA, vol. 320, no. 8, pp. 792-814. https://doi.org/10.1001/jama.2018.10060

TY - JOUR

T1 - Global mortality from firearms, 1990-2016

AU - Naghavi, Mohsen

AU - Marczak, Laurie B.

AU - Kutz, Michael

AU - Shackelford, Katya Anne

AU - Arora, Megha

AU - Miller-Petrie, Molly

AU - Aichour, Miloud Taki Eddine

AU - Akseer, Nadia

AU - Al-Raddadi, Rajaa M.

AU - Alam, Khurshid

AU - Alghnam, Suliman A.

AU - Antonio, Carl Abelardo T.

AU - Aremu, Olatunde

AU - Arora, Amit

AU - Asadi-Lari, Mohsen

AU - Assadi, Reza

AU - Atey, Tesfay Mehari

AU - Avila-Burgos, Leticia

AU - Awasthi, Ashish

AU - Quintanilla, Beatriz Paulina Ayala

AU - Barker-Collo, Suzanne Lyn

AU - Bärnighausen, Till Winfried

AU - Bazargan-Hejazi, Shahrzad

AU - Behzadifar, Masoud

AU - Behzadifar, Meysam

AU - Bennett, James R.

AU - Bhalla, Ashish

AU - Bhutta, Zulfiqar A.

AU - Bilal, Arebu Issa

AU - Borges, Guilherme

AU - Borschmann, Rohan

AU - Brazinova, Alexandra

AU - Rincon, Julio Cesar Campuzano

AU - Carvalho, Felix

AU - Castañeda-Orjuela, Carlos A.

AU - Dandona, Lalit

AU - Dandona, Rakhi

AU - Dargan, Paul I.

AU - De Leo, Diego

AU - Dharmaratne, Samath Dhamminda

AU - Ding, Eric L.

AU - Do, Huyen Phuc

AU - Doku, David Teye

AU - Doyle, Kerrie E.

AU - Driscoll, Tim Robert

AU - Edessa, Dumessa

AU - El-Khatib, Ziad

AU - Endries, Aman Yesuf

AU - Esteghamati, Alireza

AU - Faro, Andre

AU - Farzadfar, Farshad

AU - Feigin, Valery L.

AU - Fischer, Florian

AU - Foreman, Kyle J.

AU - Franklin, Richard Charles

AU - Fullman, Nancy

AU - Futran, Neal D.

AU - Gebrehiwot, Tsegaye Tewelde

AU - Gutiérrez, Reyna Alma

AU - Hafezi-Nejad, Nima

AU - Bidgoli, Hassan Haghparast

AU - Hailu, Gessessew Bugssa

AU - Haro, Josep Maria

AU - Hassen, Hamid Yimam

AU - Hawley, Caitlin

AU - Hendrie, Delia

AU - Híjar, Martha

AU - Hu, Guoqing

AU - Ilesanmi, Olayinka Stephen

AU - Jakovljevic, Mihajlo

AU - James, Spencer L.

AU - Jayaraman, Sudha

AU - Jonas, Jost B.

AU - Kahsay, Amaha

AU - Kasaeian, Amir

AU - Keiyoro, Peter Njenga

AU - Khader, Yousef

AU - Khalil, Ibrahim A.

AU - Khang, Young-Ho

AU - Khubchandani, Jagdish

AU - Kiadaliri, Aliasghar Ahmad

AU - Kieling, Christian

AU - Kim, Yun Jin

AU - Kosen, Soewarta

AU - Krohn, Kristopher J.

AU - Kumar, G. Anil

AU - Lami, Faris Hasan

AU - Lansingh, Van C.

AU - Larson, Heidi Jane

AU - Linn, Shai

AU - Lunevicius, Raimundas

AU - Abd El Razek, Hassan Magdy

AU - Abd El Razek, Muhammed Magdy

AU - Malekzadeh, Reza

AU - Malta, Deborah Carvalho

AU - Mason-Jones, Amanda J.

AU - Matzopoulos, Richard

AU - Memiah, Peter T. N.

AU - Mendoza, Walter

AU - Meretoja, Tuomo J.

AU - Mezgebe, Haftay Berhane

AU - Miller, Ted R.

AU - Mohammed, Shafiu

AU - Moradi-Lakey, Maziar

AU - Mori, Rintaro

AU - Nand, Devina

AU - Nguyen, Cuong Tat

AU - Nguyen, Quyen Le

AU - Mingrum, Dina Nur Anggraini

AU - Ogbo, Felix Akpojene

AU - et al, null

PY - 2018

Y1 - 2018

N2 - Importance: Understanding global variation in firearm mortality rates could guide prevention policies and interventions. Objective: To estimate mortality due to firearm injury deaths from 1990 to 2016 in 195 countries and territories. Design, Setting, and Participants: 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. Exposures: Firearm ownership and access. Main Outcomes and Measures: Cause-specific deaths by age, sex, location, and year. Results: 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 (P < .001; R2 = 0.21) and homicide (P < .001; R2 = 0.35). Conclusions and Relevance: 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.

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

KW - firearms accidents

KW - mortality

UR - http://hdl.handle.net/1959.7/uws:50022

U2 - 10.1001/jama.2018.10060

DO - 10.1001/jama.2018.10060

M3 - Article

SN - 0098-7484

VL - 320

SP - 792

EP - 814

JO - JAMA

JF - JAMA

IS - 8

ER -

Global mortality from firearms, 1990-2016

Abstract

Keywords

UN SDGs

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