Firearm storage practices and rates of unintentional firearm deaths in the United States

https://doi.org/10.1016/j.aap.2005.02.003Get rights and content

Abstract

Background:

The American Academy of Pediatrics and the American Medical Association recommend storing firearms unloaded and locked up to minimize the chance of injury. Although these recommendations appeal to common sense, no study has yet addressed whether firearm storage practices influence the risk of unintentional firearm injury.

Methods:

Negative binomial regression analyses were used to assess the cross sectional relation between firearm storage practices and rates of unintentional firearm death in the United States, controlling for rates of firearm prevalence, poverty and urbanization. Recently available state-level measures of household firearm prevalence and firearm storage practices were obtained from the 2002 Behavioral Risk Factor Surveillance System. Unintentional firearm death counts and population data came from the National Center for Health Statistics.

Results:

Independent of firearm prevalence, urbanization, and poverty, a disproportionately large share of unintentional firearm fatalities occurred in states where gun owners were more likely to store their firearms loaded, the greatest risk occurring in states where loaded firearms were more likely to be stored unlocked.

Conclusion:

Our findings provide empirical support for recommendations issued by the AMA and the AAP that firearms should be stored unloaded and locked, and suggest that promoting safer storage practices could save many lives.

Introduction

The circumstances involved in unintentional firearm fatalities are not well characterized. Although we know that 90% of the 11,509 Americans who died from unintentional firearm injuries between 1991 and 2000 were male and a quarter were under age eighteen (CDC, 2003b), we know little about the type of firearm involved or how the offending firearm had been stored.

Existing studies suggest that routine handling may play a role in both non-fatal (Stucky and Loder, 1991, Kennedy et al., 1993, Payne et al., 1993, Annest et al., 1995, Go DeVivo et al., 1995, Sinauer et al., 1996) and fatal (Morrow and Hudson, 1986, Cole and Patetta, 1988, Carter, 1989, Wintemute et al., 1989, Grossman et al., 1999) events. For example, among children most fatal events occurred when children were playing with guns they had found, and in at least twenty percent of the cases the child who fired the gun did not know it was loaded (Wintemute et al., 1987, Wintemute et al., 1989). Of note, firearms owned by relatives or friends living in households other than the victim's accounted for half (49%) of all unintentional injuries and deaths (Grossman et al., 1999), suggesting that an ideal measure of firearm exposure captures firearm-related characteristics (e.g. storage practices) not only in the victim's home, but also in the community.

Two empirical studies (a case–control study (Wiebe, 2003) and an ecologic study (Miller et al., 2001)) have evaluated whether household firearm ownership is related to the rate of unintentional firearm deaths in the United States. Both found a strong relation between household firearm ownership and rates of unintentional firearm deaths. To our knowledge no study has yet examined the relation between firearm storage practices and unintentional firearm deaths. Nonetheless, the American Academy of Pediatrics (1996) and the American Medical Association (1995) have issued specific recommendations regarding how firearms ought to be stored to minimize the chance of firearm injury. To our knowledge, the current study is the first to investigate the empirical basis of these recommendations with respect to unintentional firearm deaths.

Section snippets

Dependent variable: mortality data

The study group consisted of all unintentional firearm deaths (International Classification of Diseases, Ninth Revision JICD-91, E922.0-E922.9; Tenth Edition W32-W34) in the US between 1991 and 2000. Death counts and corresponding population data come from the National Center for Health Statistics (NCHS) mortality files (CDC, 2003a, CDC, 2003b). Firearm deaths of undetermined intent were excluded from analyses (ICD-9 E985, ICD-10 Y22-Y24). Mortality data were collected by sex and age (0–17,

Results

Eleven thousand five hundred and nine (11,509) people died from unintentional firearm injuries over the 10-year study period. The rate of unintentional firearm fatalities was 0.43 per 100,000 person-years and ranged from 0.05 (Rhode Island) to 2.37 (Alaska) per 100,000 person-years (Table 1). In 2002, 33% of Americans lived in households with firearms (10% in Hawaii to 63% in Wyoming), 22% of whom lived in households with loaded guns (6% in North Dakota to 34% in Texas), and 13% of whom lived

Conclusion

For a given level of firearm prevalence, in states where fewer firearm owners store their guns loaded rates of unintentional firearm deaths are lower. Areas where gun owners tend to store firearms both loaded and unlocked have the highest rates of unintentional firearm deaths. These findings are consistent with previous work suggesting that many unintentional firearm shootings occur during routine handling, often when the shooter mistakenly believes the firearm is not loaded (Morrow and Hudson,

Acknowledgements

Dr. Miller assumes responsibility for the integrity of the work as a whole, from inception to published article. Drs. Miller, Azrael and Hemenway made substantial contributions to conception and design of the study as well as to the analysis and interpretation of data. Ms Vriniotis played a major role in the acquisition of data. Dr. Miller wrote the manuscript; Drs. Hemenway, Azrael and Ms Vriniotis revised it critically for important intellectual content. All authors have given final approval

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