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JAMA. 2018 Aug 28;320(8):792-814. doi: 10.1001/jama.2018.10060.

Global Mortality From Firearms, 1990-2016.

Global Burden of Disease 2016 Injury Collaborators, Naghavi M1, Marczak LB1, Kutz M1, Shackelford KA1, Arora M1, Miller-Petrie M1, Aichour MTE2, Akseer N3, Al-Raddadi RM4, Alam K5, Alghnam SA6, Antonio CAT7, Aremu O8, Arora A9,10, Asadi-Lari M11,12, Assadi R13, Atey TM14, Avila-Burgos L15, Awasthi A16,17, Ayala Quintanilla BP18,19, Barker-Collo SL20, Bärnighausen TW21,22, Bazargan-Hejazi S23,24, Behzadifar M25, Behzadifar M26, Bennett JR1, Bhalla A27, Bhutta ZA3,28, Bilal AI29, Borges G30, Borschmann R31,32, Brazinova A33, Campuzano Rincon JC34,35, Carvalho F36, Castañeda-Orjuela CA37,38, Dandona L1,17, Dandona R1,17, Dargan PI39,40, De Leo D41, Dharmaratne SD1,42, Ding EL43, Phuc Do H44, Doku DT45,46, Doyle KE47, Driscoll TR48, Edessa D49, El-Khatib Z50, Endries AY51, Esteghamati A52, Faro A53, Farzadfar F54, Feigin VL1,55, Fischer F56, Foreman KJ1, Franklin RC57, Fullman N1, Futran ND58, Gebrehiwot TT59, Gutiérrez RA60, Hafezi-Nejad N61,62, Haghparast Bidgoli H63, Hailu GB64, Haro JM65,66, Hassen HY67,68, Hawley C1, Hendrie D69, Híjar M70,71, Hu G72, Ilesanmi OS73, Jakovljevic M74, James SL1, Jayaraman S75, Jonas JB76,77, Kahsay A78, Kasaeian A79,80, Keiyoro PN81, Khader Y82, Khalil IA1, Khang YH83,84, Khubchandani J85, Ahmad Kiadaliri A86, Kieling C87,88, Kim YJ89, Kosen S90, Krohn KJ1, Kumar GA17, Lami FH91, Lansingh VC92,93, Larson HJ1,94, Linn S95, Lunevicius R96,97, Magdy Abd El Razek H98, Magdy Abd El Razek M99, Malekzadeh R100,101, Carvalho Malta D102, Mason-Jones AJ103, Matzopoulos R104,105, Memiah PTN106, Mendoza W107, Meretoja TJ108,109, Mezgebe HB110, Miller TR69,111, Mohammed S21,112, Moradi-Lakeh M113, Mori R114, Nand D115,116, Tat Nguyen C44, Le Nguyen Q44, Ningrum DNA117,118, Akpojene Ogbo F119, Olagunju AT120,121, Patton GC122,123, Phillips MR124, Polinder S125, Pourmalek F126, Qorbani M127, Rahimi-Movaghar A128, Rahimi-Movaghar V129, Rahman M130, Rai RK131,132, Ranabhat CL133, Rawaf DL134,135, Rawaf S136,137, Rowhani-Rahbar A138, Safdarian M139, Safiri S140, Sagar R141, Salama JS1, Sanabria J142,143, Santric Milicevic MM144, Sarmiento-Suárez R145, Sartorius B146, Satpathy M147, Schwebel DC148, Seedat S149, Sepanlou SG100,101, Shaikh MA150, Sharew NT151, Shiue I152, Singh JA153,154, Sisay M49, Skirbekk V155, Soares Filho AM156, Stein DJ157,158, Stokes MA159, Sufiyan MB160, Swaroop M161, Sykes BL162, Tabarés-Seisdedos R163, Tadese F164, Tran BX165, Thanh Tran T44, Ukwaja KN166, Vasankari TJ167, Vlassov V168, Werdecker A169, Ye P170, Yip P171, Yonemoto N172, Younis MZ173,174, Zaidi Z175,176, El Sayed Zaki M177, Hay SI1, Lim SS1, Lopez AD1,178, Mokdad AH1, Vos T1, Murray CJL1.

Author information

1
Institute for Health Metrics and Evaluation, University of Washington, Seattle.
2
Higher National School of Veterinary Medicine, Algiers, Algeria.
3
Centre for Global Child Health, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
4
Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
5
School of Population and Global Health, University of Western Australia, Perth, WA, Australia.
6
Department of Population Health, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
7
Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines.
8
Department of Public and Community Health, Birmingham City University, Birmingham, England.
9
School of Science and Health, Western Sydney University, Penrith, NSW, Australia.
10
Oral Health Services, Sydney Local Health District, Sydney, Australia.
11
Department of Epidemiology and Biostatistics, Iran University of Medical Sciences, Tehran, Iran.
12
International Relations Department, Iranian Ministry of Health and Medical Education, Tehran, Iran.
13
Education Development Center, Mashhad University of Medical Sciences, Mashhad, Iran.
14
Department of Pharmacy, Mekelle University, Mekelle, Ethiopia.
15
Center of Health System Research, The National Institute of Public Health, Cuernavaca, Mexico.
16
Indian Institute of Public Health, Gandhinagar, India.
17
Public Health Foundation of India, Gurugram, India.
18
The Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia.
19
General Office for Research and Technological Transfer, Peruvian National Institute of Health, Lima, Peru.
20
School of Psychology, University of Auckland, Auckland, New Zealand.
21
Institute of Public Health, Heidelberg University, Heidelberg, Germany.
22
Department of Global Health and Population, Harvard University, Boston, Massachusetts.
23
Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, California.
24
Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles.
25
Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorranmabad, Iran.
26
Faculty of Health and Nutrition, Lorestan University of Medical Sciences, Khorranmabad, Iran.
27
Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
28
Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
29
School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia.
30
Department of Epidemiology, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico.
31
Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia.
32
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
33
Institute of Epidemiology, Comenius University, Bratislava, Slovakia.
34
National Institute of Health, Cuernavaca, Mexico.
35
Escuela de Medicina, Universidad Valle de Cuernavaca, Cuernavaca, Mexico.
36
Ucibio, Requimte, Faculty of Pharmacy, University of Porto, Porto, Portugal.
37
Colombian National Health Observatory, Instituto Nacional de Salud, Bogota, Colombia.
38
Epidemiology and Public Health Evaluation Group, Universidad Nacional de Colombia, Bogota, Colombia.
39
Department of Clinical Toxicology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
40
Department of Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
41
Australian Institute for Suicide Research and Prevention, Griffith University, Mt Gravatt, QLD, Australia.
42
Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
43
Harvard School of Public Health, Department of Nutrition, Harvard University, Boston, Massachusetts.
44
Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam.
45
Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
46
Faculty of Social Sciences, University of Tampere, Tampere, Finland.
47
School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University (RMIT), Bundoora, VIC, Australia.
48
Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
49
School of Pharmacy, Haramaya University, Harar, Ethiopia.
50
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
51
Department of Public Health, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
52
Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.
53
Department of Psychology, Federal University of Sergipe, Sao Cristovao, Brazil.
54
Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.
55
National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand.
56
Department of Public Health Medicine, Bielefeld University, Bielefeld, Germany.
57
College of Public Health Medical and Veterinary Science, James Cook University, Douglas, QLD, Australia.
58
School of Medicine Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle.
59
Department of Epidemiology and Biostatistics, Jimma University, Jimma, Ethiopia.
60
Epidemiological and Psychosocial Investigations, National Institute of Psychiatry Ramon de la Fuente, Mexico City, Mexico.
61
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
62
Department of Radiology, Johns Hopkins University, Baltimore, Maryland.
63
Institute for Global Health, University College London, London, United Kingdom.
64
Biomedical Science Division, School of Medicine, Mekelle University, Mekelle, Ethiopia.
65
Research Unit, Parc Sanitari Sant Joan de Déu (CIBERSAM), Sant Boi de Llobregat, Spain.
66
Department of Medicine, Universitat de Barcelona, Barcelona, Spain.
67
Department of Public Health, Mizan-Tepi University, Mizan Teferi, Ethiopia.
68
Unit of Epidemiology and Social Medicine, University Hospital Antwerp, Wilrijk, Belgium.
69
School of Public Health, Curtin University, Bentley, Perth, WA, Australia.
70
Research Coordination, Fundación Entornos AC, Cuernavaca, Mexico.
71
CISS, National Institute of Public Health, Cuernavaca, Mexico.
72
Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.
73
Department of Public Health and Community Medicine, University of Liberia, Monrovia, Liberia.
74
Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia.
75
Department of Surgery, Virginia Commonwealth University, Richmond.
76
Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
77
Capital Medical University, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Laboratory, Beijing, China.
78
Department of Nutrition and Dietetics, Mekelle University, Mekelle, Ethiopia.
79
Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.
80
Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran.
81
School of Continuing and Distance Education, University of Nairobi, Nairobi, Kenya.
82
Public Health and Community Medicine, Jordan University of Science and Technology, Alramtha, Jordan.
83
Department of Health Policy and Management, College of Medicine, Seoul National University, Seoul, South Korea.
84
Institute of Health Policy and Management, SNU Medical Research Center, Seoul National University, Seoul, South Korea.
85
Department of Nutrition and Health Science, Ball State University, Muncie, Indiana.
86
Clinical Epidemiology Unit, Lund University, Lund, Sweden.
87
Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
88
Child & Adolescent Psychiatry Division, Hospital of Clinics of Porto Alegre, Porto Alegre, Brazil.
89
School of Medicine, Xiamen University Malaysia, Sepang, Malaysia.
90
Independent Consultant, Jakarta, Indonesia.
91
Department of Community and Family Medicine, Academy of Medical Science, Baghdad, Iraq.
92
Helpmesee, New York, New York.
93
Department of International Relations, Mexican Institute of Ophthalmology, Queretaro, Mexico.
94
Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.
95
School of Public Health, University of Haifa, Haifa, Israel.
96
General Surgery Department, Aintree University Hospital National Health Service Foundation Trust (NHS), Liverpool, United Kingdom.
97
School of Medicine, University of Liverpool, Liverpool, United Kingdom.
98
Department of Cardiology, Damietta University, Damietta, Egypt.
99
Ophthalmology Department, Aswan Faculty of Medicine, Aswan, Egypt.
100
Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
101
Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
102
Departamento Materno Infantil e Saúde Publica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
103
Department of Health Sciences, University of York, York, United Kingdom.
104
Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
105
School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
106
Department of Public Health, University of West Florida, Pensacola.
107
Peru Country Office, United Nations Population Fund (UNFPA), Lima, Peru.
108
Comprehensive Cancer Center, Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland.
109
Department of Surgery, University of Helsinki, Helsinki, Finland.
110
School of Pharmacy, Academy of Medical Science, Baghdad, Iraq.
111
Pacific Institute for Research & Evaluation, Calverton, Maryland.
112
Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria.
113
Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran.
114
Department of Health Policy, National Center for Child Health and Development, Setagaya, Japan.
115
Health Information Unit, Ministry of Health, Suva, Fiji.
116
Accamargo Cancer Center, São Paulo, Brazil.
117
Public Health Department, Semarang State University, Kota Semarang, Indonesia.
118
Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei City, Taiwan.
119
Western Sydney University, Penrith, NSW, Australia.
120
School of Medicine, University of Adelaide, Adelaide, SA, Australia.
121
Department of Psychiatry, University of Lagos, Lagos, Nigeria.
122
Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
123
Department of Paediatrics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
124
Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China.
125
Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.
126
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
127
Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
128
Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.
129
Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
130
Research and Evaluation Division, BRAC (Bangladesh Rehabilitation Assistance Committee), Dhaka, Bangladesh.
131
Society for Health and Demographic Surveillance, Suri, India.
132
Department of Economics, University of Göttingen, Göttingen, Germany.
133
Institute for Poverty Alleviation and International Development, Yonsei University, South Korea.
134
WHO Collaborating Centre for Public Health Education & Training, Imperial College London, London, United Kingdom.
135
University College London Hospitals, London, United Kingdom.
136
Department of Primary Care and Public Health, Imperial College London, London, United Kingdom.
137
Public Health England, London, United Kingdom.
138
Department of Epidemiology, University of Washington, Seattle.
139
Sina Trauma and Surgery Center, Iran University of Medical Sciences, Tehran, Iran.
140
Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran.
141
Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
142
Department of Surgery, Marshall University, Huntington, West Virginia.
143
Department of Nutrition and Preventive Medicine, Case Western Reserve University, Cleveland, Ohio.
144
Faculty of Medicine, Institute of Social Medicine, Centre School of Public Health and Health Management, University of Belgrade, Belgrade, Serbia.
145
Department of Health and Society, Faculty of Medicine, Universidad Ciencias Aplicadas y Ambientales, Bogotá, Colombia.
146
Department of Public Health Medicine, University of Kwazulu-Natal, Durban, South Africa.
147
UGC Centre of Advanced Study in Psychology, Utkal University, Bhubaneswar, India.
148
Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama.
149
Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
150
Independent Consultant, Karachi, Pakistan.
151
College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia.
152
Instituts Für Medizinische Epidemiologie, Biometrie Und Informatik, Martin Luther University Halle-Wittenberg, Haale, Germany.
153
School of Medicine, University of Alabama at Birmingham.
154
Department of Epidemiology, University of Alabama at Birmingham.
155
Norwegian Institute of Public Health, Oslo, Norway.
156
Department of Diseases and Noncommunicable Diseases and Health Promotion, Federal Ministry of Health, Brasilia, Brazil.
157
South African Medical Research Council, Cape Town, South Africa.
158
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
159
School of Psychology, Deakin University, Burwood, VIC, Australia.
160
Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria.
161
Department of Surgery, Northwestern University, Chicago, Illinois.
162
Department of Criminology, Law, & Society, University of California Irvine.
163
Department of Medicine, University of Valencia, Valencia, Spain.
164
Department of Public Health, Wollo University, Dessie, Ethiopia.
165
Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam.
166
Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria.
167
UKK Institute for Health Promotion Research, Tampere, Finland.
168
Department of Health Care Management and Economics, National Research University Higher School of Economics, Moscow, Russia.
169
Demographic Change and Ageing, Federal Institute for Population Research, Wiesbaden, Germany.
170
Division of Injury Prevention and Mental Health Improvement, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Xicheng District, China.
171
Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong SAR, China.
172
Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan.
173
Healthcare Management-Health Economics & Finance/Global Health, Jackson State University, Jackson, Missouri.
174
Research Center for Public Health, Tsinghua University, Beijing, China.
175
Department of Epidemiology, University Hospital of Setif, Setif, Algeria.
176
Faculty of Medical Sciences, A.C.S. Medical College and Hospital, Algiers, Algeria.
177
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
178
School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.

Abstract

Importance:

Understanding global variation in firearm mortality rates could guide prevention policies and interventions.

Objective:

To estimate mortality due to firearm injury deaths from 1990 to 2016 in 195 countries and territories.

Design, Setting, and Participants:

This study used deidentified aggregated data including 13 812 location-years of vital registration data to generate estimates of levels and rates of death by age-sex-year-location. The proportion of suicides in which a firearm was the lethal means was combined with an estimate of per capita gun ownership in a revised proxy measure used to evaluate the relationship between availability or access to firearms and firearm injury deaths.

Exposures:

Firearm ownership and access.

Main Outcomes and Measures:

Cause-specific deaths by age, sex, location, and year.

Results:

Worldwide, it was estimated that 251 000 (95% uncertainty interval [UI], 195 000-276 000) people died from firearm injuries in 2016, with 6 countries (Brazil, United States, Mexico, Colombia, Venezuela, and Guatemala) accounting for 50.5% (95% UI, 42.2%-54.8%) of those deaths. In 1990, there were an estimated 209 000 (95% UI, 172 000 to 235 000) deaths from firearm injuries. Globally, the majority of firearm injury deaths in 2016 were homicides (64.0% [95% UI, 54.2%-68.0%]; absolute value, 161 000 deaths [95% UI, 107 000-182 000]); additionally, 27% were firearm suicide deaths (67 500 [95% UI, 55 400-84 100]) and 9% were unintentional firearm deaths (23 000 [95% UI, 18 200-24 800]). From 1990 to 2016, there was no significant decrease in the estimated global age-standardized firearm homicide rate (-0.2% [95% UI, -0.8% to 0.2%]). Firearm suicide rates decreased globally at an annualized rate of 1.6% (95% UI, 1.1-2.0), but in 124 of 195 countries and territories included in this study, these levels were either constant or significant increases were estimated. There was an annualized decrease of 0.9% (95% UI, 0.5%-1.3%) in the global rate of age-standardized firearm deaths from 1990 to 2016. Aggregate firearm injury deaths in 2016 were highest among persons aged 20 to 24 years (for men, an estimated 34 700 deaths [95% UI, 24 900-39 700] and for women, an estimated 3580 deaths [95% UI, 2810-4210]). Estimates of the number of firearms by country were associated with higher rates of firearm suicide (P < .001; R2 = 0.21) and homicide (P < .001; R2 = 0.35).

Conclusions and Relevance:

This study estimated between 195 000 and 276 000 firearm injury deaths globally in 2016, the majority of which were firearm homicides. Despite an overall decrease in rates of firearm injury death since 1990, there was variation among countries and across demographic subgroups.

PMID:
30167700
PMCID:
PMC6143020
DOI:
10.1001/jama.2018.10060
[Indexed for MEDLINE]
Free PMC Article

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