Statement of Purpose This time-series analysis examines the relationship between gun suicides/homicides and (1) health care expenditures, (2) police expenditures, and (3) new building permit valuation at the county level.

Methods/Approach The outcome in this study was the number of firearm suicides and homicides in each county in the US per year (1999–2018). The three primary exposures were (1) health facility and health payroll expenditures (2) police and corrections expenditures and (3) new building permit valuation per county per year. Data were analyzed using repeated measures GEE with a quasi-poisson distribution. Median age and income,% below the federal poverty line,% white,% high school educated,% single mother homes, urbanicity, gun law permissiveness and year were adjusted for in the analysis, and an offset of population was included.

Results On average, every hundred million dollars spent on health facilities and payroll was associated with a significant 0.2% (95%CI 0.08 to 0.3%) lower per capita rate of firearm suicides. Expenditures on both police/corrections and new building permits were not significant. Every hundred million dollars spent on health facilities and payroll was associated with a 0.3% (95%CI: 0.2% to 0.3%) higher per capita rate of firearm homicide. Every hundred million dollars spent on police and corrections was associated with a 2.2% (1.0% to 3.5%) lower per capita rate of firearm suicide. Money spent on building permits was not associated with homicide deaths.

Conclusion The data in this study is cross-sectional and interaction with urbanicity needs to be explored. These modest associations indicate that increasing money on hospital care, police/corrections, and new buildings in a county may not be the most effective use of money for reducing firearm deaths.

Significance When funding is limited, it is important to know where money is best spent to prevent gun related deaths.