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Income inequality and firearm homicide in the US: a county-level cohort study
  1. Ali Rowhani-Rahbar1,2,3,
  2. Duane Alexander Quistberg3,4,
  3. Erin R Morgan1,3,
  4. Anjum Hajat1,
  5. Frederick P Rivara1,2,3
  1. 1 Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
  2. 2 Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
  3. 3 Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington, USA
  4. 4 Department of Environmental and Occupational Health, Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Ali Rowhani-Rahbar, Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA98195, USA; rowhani{at}


Objective Income inequality has been rising in the US and thought to be associated with violence especially homicide. About 75% of homicides involve firearms. We quantified the association between county-level income inequality and all-race/ethnicity and race/ethnicity-specific firearm homicide rates among individuals aged 14–39 years.

Methods We conducted a cohort study of US counties to examine the association of Gini Index (ranging from 0 [perfect income equality] to 1.0 [perfect income inequality]) separately measured in 1990 and 2000 with all-race/ethnicity and race/ethnicity-specific firearm homicide rates in 2005–2015. Generalised linear mixed models with Poisson distribution including a random intercept for state provided IRRs and 95% CIs. Bayesian Poisson-lognormal hierarchical modelling with integrated nested Laplace approximations was used in exploratory spatial analyses. Models accounted for county-level age, sex and race/ethnicity composition, crime rate, deprivation, social capital, urbanicity, and firearm ownership.

Findings The Gini Index was associated with firearm homicide rates among all races/ethnicities. After accounting for contextual determinants of firearm homicide, the association persisted among African–Americans. In this group, a 1 SD greater Gini Index in 1990 (IRR=1.09; 95% CI 1.02 to 1.16) and 2000 (IRR=1.09; 95% CI 1.01 to 1.17) was associated with greater firearm homicide rates in 2005–2015. Exploratory spatial analyses did not materially change the results.

Conclusion Policies addressing the gap between the rich and the poor deserve further considerations for reducing firearm homicide rates. Incorporating income inequality to refine measures of socioeconomic position may advance public health and clinical research and practice for firearm violence prevention.

  • firearms
  • homicide
  • income inequality
  • race
  • African-American

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  • Contributors AR-R and FPR contributed to the study concept and design. All authors contributed to acquisition, analysis or interpretation of data. AR-R drafted the manuscript. All authors contributed to critical revision of the manuscript for important intellectual content. DAQ and ERM conducted statistical analyses. All authors provided administrative, technical or material support. AR-R and FPR contributed to study supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study of deidentified data was exempt from Institutional Review Board approval by the Human Subjects Division of the University of Washington.

  • Provenance and peer review Not commissioned; externally peer reviewed.