Statement of purpose Violent homicide is a major cause of death and a driver of health disparities in the US. It is not clear why some neighborhoods with high concentrations of racial and ethnic minority residents have high violent homicide incidence, while others do not experience violent homicide. The aim of this study is to identify the social and physical environmental conditions that contribute to increased violent homicide incidence in US neighborhoods, independent of racial and ethnic composition.

Methods/Approach Using the CDC’s National Violent Death Reporting System (NVDRS), we conducted an ecological case-control study to compare environmental conditions in the 250 ZIP codes with the highest violent homicide death rate in 2017 (cases) to 250 ZIP codes that did not experience any violent homicide deaths in 2017 (controls). Cases were matched 1:1 to interstate controls based on demographic profiles. A multi-level logistic regression estimated the odds that ZIP codes have high incidence of violent homicide according to social and physical environmental conditions measured at both the ZIP code- and state-levels.

Results We found that local neighborhood socioeconomic demographics were associated with incidence of violent homicide death, independent of age, race/ethnicity, and sex. Associations were strongest for lower median household income and greater economic inequality at the ZIP code-level. ZIP-code characteristics explained associations between state-level characteristics and violent homicide occurrence.

Conclusions Living in higher-income and less densely populated ZIP codes was associated with decreased risks of violent homicide. Local ZIP code characteristics are stronger determinants of homicide incidence than state-level characteristics.

Significance Area-based interventions that would improve neighborhood social and economic conditions may reduce violent homicide incidence.