Firearms in US homes as a risk factor for unintentional gunshot fatality
Introduction
Firearms are present in approximately one-third of US households (Davis and Smith, 2000). A national estimate suggests that the privately owned firearm stock sums to nearly 200 million guns (Cook and Ludwig, 1997). Commonly cited reasons for firearm ownership are sport shooting, hunting, and self protection (Cook and Ludwig, 1997). Unfortunately, the handling and use of firearms can have serious unintended consequences that include unintentional gunshot injuries and death.
In 1989–1998, approximately 3500 children and 9300 adults died in unintentional shootings in the US (National Center for Health Statistics, 1989-1998). Although it has been declining annually, death from unintentional shootings remains an important public health problem. On average two people die each day in the US from unintentional gunshot injuries (Minino and Smith, 2001). Unintentional injuries that are fatal represent only part of the harm (Annest et al., 1995). For every unintentional gunshot fatality in the US, another 13 people are treated for non-fatal gunshot injuries in hospital emergency departments (Gotsch et al., 2001).
Evidence that firearm availability is a risk factor for homicide (Kellermann et al., 1993, Cummings et al., 1997) and suicide (e.g. Kellermann et al., 1992, Cummings et al., 1997) comes from multiple case-control studies. By contrast, case-control designs have not been used to investigate a link between firearm availability and death by unintentional shooting. State-level research provides evidence that such an association exists. In the US during 1979–1997, the rate of unintentional gunshot fatalities in states with the highest levels of gun availability was nine times higher than the rate in states with the lowest levels of gun availability (Miller et al., 2001). During 1988–1997, the rate of child unintentional gunshot deaths was 16 times higher in states where guns were most prevalent compared to states where guns were least prevalent (Miller et al., 2002). Results from a study of child deaths in California provide evidence that the association may stem from a gun kept in the decedent’s home. During 1977–1983, the prevalence of a handgun in homes of children killed in unintentional gunshot shootings was two times higher than predicted based on the level of handgun availability in homes in the region (Wintemute et al., 1989). This article presents a case-control study that further examined the topic.
Section snippets
Methods
The purpose was to derive an estimate of the relative risk for unintentional gunshot fatality associated with living in a home where firearms were or were not present. The subjects consisted of a sample of adults who died from unintentional gunshot injuries in the US and living controls. The cases came from the 1993 National Mortality Followback Survey (NMFS, 1993) (National Center for Health Statistics, 1998). The NMFS data combine information from surveys and death certificates and contain
Results
Eighty-four unintentional shooting fatality case subjects were identified. Twelve were killed with a handgun, four with a shotgun, three with a hunting rifle, and 65 with an unspecified type of gun. Twenty controls were successfully matched by sex, age group, race, and region to 63 of the 84 cases. The remaining cases were matched with between four and 18 controls (average=13). Table 1 shows characteristics of the cases and controls.
The prevalence of one or multiple firearms was considerably
Discussion
This study of a sample of adults in the US provides evidence that the presence of a gun in the home was a risk factor for unintentional shooting death. Having multiple guns appeared to compound the hazard, as did having handguns in particular. This study is the first on the topic, to my knowledge, to use a case-control design to estimate the magnitude of these relations. Hence, it will be important to compare the observed effect estimates with those derived from subsequent studies. Nonetheless,
Acknowledgements
I wish to acknowledge Susan B. Sorenson for conceptual advice, Hal Morgenstern for methodological advice, Colin Loftin for suggesting the NHIS as a source of controls, and Catherine Taylor, Katherine Vittes and anonymous reviewers for helpful suggestions, and Michael Mitcheu and the UCLA Academic Technology Services consultants. The methodological framework was developed in conjunction with my dissertation committee members: Joan Petersilia, Richard McCleary, Colin Loftin, Valerie Jenness, and
References (37)
Accidental firearm fatalities and injuries among recreational hunters
An. Emer. Med.
(1989)- et al.
Firearm availability and unintentional firearm deaths
Accident Anal. Prev.
(2001) - et al.
National estimates of non-fatal firearm-related injuries: Beyond the tip of the iceberg
J. Am. Med. Assoc.
(1995) - Azrael, D., Miller, M., and Hemenway, D., 2000. Are household firearms stored safely? It depends on whom you ask....
- Centers for Disease Control and Prevention. Sample Design of the 1993 National Mortality Followback Survey. No date....
- et al.
Hunting firearm injuries, North Carolina
Am. J. Public Health
(1988) - Cook, P.J., Ludwig, J., 1997. Guns in America: National Survey on Private Ownership and Use of Firearms, NCJ 165476, US...
- et al.
The association between the purchase of a handgun and homicide or suicide
Am. J. Public Health
(1997) - Davis, J.A., Smith, T.W., 2000. General Social Surveys, 1972–2000. (machine-readable data file). Principal...
- et al.
Unintentional gun injuries, firearm design, and prevention: what we know, what we need to know, and what can be done
J. Urban Health
(2002)
Some surprising results about covariate adjustment in logistic regression
Int. Stat. Rev.
Validating survey responses to questions about gun ownership among owners of registered handguns
Am. J. Epid.
Suicide in the home in relation to gun ownership
New Engl. J. Med.
Gun ownership as a risk factor for homicide in the home
New Engl. J. Med.
Estimating risk and rate levels, ratios and differences in case-control studies
Stat. Med.
Analyzing incomplete political science data: An alternative algorithm for multiple imputation
Am. Pol. Sci. Rev.
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