Firearm-Related Death: International Comparison

Rates of firearm-related death in the U.S. are significantly higher than rates in other high-income countries. Data from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) found that, in 2015, the overall firearm-related death rate was 11.4 times higher in the U.S. compared to 28 other high-income nations.⁶ During the same year, 83.7% of all firearm-related deaths across the 29 countries studied occurred in the U.S. despite the U.S. only accounting for about 31% of the combined population.⁶

The discrepancy between the U.S. and peer nations is even more stark when it comes to firearm-related mortality among children and adolescents. Across the 29 countries referenced, in 2015, more than 9 in 10 children (ages 0–14) who died from firearm-related injuries lived in the U.S. (97% of children ages 0–4, and 92% of children ages 5–14).⁶ More recently, data from the Institute for Health Metrics and Evaluation (IHME) showed that, in 2019, the rate of firearm mortality among children and adolescents (ages 1–19) in the U.S. (36.4 per one million) was more than 5 times the rate of firearm mortality among the same age group in Canada (6.2 per one million), about 18 times the rate of firearm mortality in Sweden (2.0 per one million), and more than 22 times the rate of firearm mortality in Australia (1.6 per one million) (Figure 4).⁷

FIGURE 4

Comparison of firearm mortality rates among children and adolescents in select OECD nations.

In 2015, the overall firearm-related death rate was 11.4 times higher in the U.S. compared to 28 other high-income nations.⁶

Firearm-Related Death: Disproportionate Impacts

Firearm homicides and suicides are not equally distributed, and disparities have been longstanding across population groups in the U.S. In 2022, Black persons endured the highest age-adjusted firearm homicide rates across all ages (27.0 per 100,000 (Black or African American) as compared to 6.2 per 100,000 (all races/ethnicities)^c).² In 2022, White individuals ages 45 years and older had the highest rate of firearm suicide (14.8 per 100,000 vs. 11.1 per 100,000 all races/ethnicities ≥45 years); while the firearm suicide rate for people under age 45 years old was highest among American Indian or Alaska Native (AI/AN) persons (12.3 per 100,000 vs. 5.9 per 100,000 all races/ethnicities <45 years).² The firearm suicide rate was also significantly higher among Veterans in 2021: 62.4% higher for Veteran men than for non-Veteran men and 281.1% higher for Veteran women than for non-Veteran women.⁸

There are noteworthy disparities in firearm-related deaths by sex. In 2022, males were approximately six times as likely to die from firearm-related injury than females (41,302 firearm-related deaths among males and 6,902 firearm-related deaths among females).² Despite higher numbers of total firearm-related deaths among males, the intersection of intimate partner violence (IPV) and firearm violence disproportionately impacts females. Firearms are used in about 50% of all IPV-related homicides.^{9, 10} In 2021, the proportion of homicides attributable to IPV was five times higher for female victims as compared to male victims.¹¹

Among youth, disparities by sex and race are also evident. In 2022, male children and adolescents (ages 1–19) were more than five times as likely than their female counterparts to die from a firearm-related injury (3,926 firearm deaths for males and 677 firearm deaths for females).² When assessing types of firearm-related deaths in 2022 among White children and adolescents (ages 1–19), 29% were homicides (352 of 1,194) and 63% were suicides (757 of 1,194).² Among Black children and adolescents (ages 1–19), 86% of firearm-related deaths were homicides (1,961 of 2,279) and 10% were suicides (220 of 2,279).² Among Hispanic children and adolescents (all-races), 76% were homicides (688 of 909) and 18% were suicides (168 of 909); among Asian/Native Hawaiian/Pacific Islander children and adolescents, 39% were homicides (26 of 66) and 55% were suicides (36 of 66); and among American Indian or Alaska Native children and adolescents, 44% were homicides (29 of 66) and 48% were suicides (32 of 66).² CDC data for 2022 show that the firearm suicide rate among Black adolescents (age 10–19) surpassed the rate among White adolescents (age 10–19) for the first time on record.²

Overall, in 2022, Black children and adolescents accounted for about half of all firearm-related deaths among U.S. children and adolescents, despite making up only 14% of the U.S. child and adolescent population.^{2, 12}

Firearm-Related Death: Mass Shootings

While mass shooting^d deaths represent only about 1% of all firearm-related deaths in the U.S., the number of mass shooting incidents is increasing.^{13, 14} According to data published by Gun Violence Archive, the U.S. experienced more than 600 mass shooting incidents each year between 2020 and 2023, compared to an average of less than 400 annual mass shooting incidents between 2015 and 2018.¹⁵ An analysis of the National Violent Death Reporting System found that compared to single homicides (1 victim) and multiple homicides (2–3 victims), mass homicides^e (4 or more victims, besides the perpetrator) had the highest proportion of female victims (52%), the highest proportion of White victims (56%), and the highest proportion of child victims (more than a quarter were younger than 18 years old).¹⁶ Another analysis of mass shootings between 2014–2019 found that most incidents were associated with domestic violence (59%), which was defined as at least one victim being a dating partner or family member of the perpetrator, and that domestic violence-related mass shootings had higher average case fatality rates than those unrelated to domestic violence (84% vs 63%).¹⁷

Despite accounting for a relatively small number of firearm deaths, mass shooting incidents cause outsized collective trauma on society and have a strong negative effect on the public’s perception of safety (see “Collective Toll” section on page 14). More than three-quarters of adults (79%) in the U.S. report experiencing stress from the possibility of a mass shooting, and one in three adults (33%) say fear prevents them from going to certain places or events.¹⁸

More than three-quarters of adults (79%) in the U.S. report experiencing stress from the possibility of a mass shooting, and one in three adults (33%) say fear prevents them from going to certain places or events.¹⁸

Mass shootings elicit significant fear and concern among the public and can lead to misconceptions about perpetrator characteristics. While findings suggest that perpetrators of mass homicides are more likely to experience mental health challenges than perpetrators of single homicides,¹⁶ research also supports that one’s mental health diagnosis or psychological profile alone is not a strong predictor of perpetrating violence of any type, including a mass shooting.^{19, 20, 21} An FBI report that examined active shooter incidents in the U.S. between 2000–2013 could only verify that one quarter of perpetrators had been diagnosed with a mental illness of any kind prior to the offense^f.¹⁹ Importantly, most people with serious mental illness are not violent against others.^{22, 23} In fact, people with serious mental illnesses^g are more likely to be victims of violence compared to the general population, even after controlling for demographic differences.^{23, 24}

Other individual and interpersonal level factors, outside of mental health diagnoses, may also play a role in the risk of perpetrating a mass homicide.^{19, 21, 25, 26} According to a 2023 Department of Homeland Security report on mass attacks in public spaces (the majority of which are perpetrated with firearms) from 2016–2020, about a quarter (24%) of perpetrators had a diagnosed mental health condition prior to or at the time of their attack^h, whereas nearly all attackers (93%) experienced at least one significant stressor within five years prior to the attack and 77% experienced such stressors within one year.²⁶ These acute and/or persistent life stressors involved romantic and family relationships (51%), such as death of a loved one or divorce; employment issues (32%), such as poor performance or termination; and negative social interactions (19%), such as being bullied in school or experiencing social exclusion, among others.²⁶