Urban-rural shifts in intentional firearm death: different causes, same results

Abstract

Objectives: We analyzed urban-rural differences in intentional firearm death.

Methods: We analyzed 584629 deaths from 1989 to 1999 assigned to 3141 US counties, using negative binomial regressions and an 11-category urban-rural variable.

Results: The most urban counties had 1.03 (95% confidence interval [CI]=0.87, 1.20) times the adjusted firearm death rate of the most rural counties. The most rural counties experienced 1.54 (95% CI=1.29, 1.83) times the adjusted firearm suicide rate of the most urban. The most urban counties experienced 1.90 (95% CI=1.50, 2.40) times the adjusted firearm homicide rate of the most rural. Similar opposing trends were not found for nonfirearm suicide or homicide.

Conclusions: Firearm suicide in rural counties is as important a public health problem as firearm homicide in urban counties. Policymakers should become aware that intentional firearm deaths affect all types of communities in the United States.

Figures

FIGURE 1—

Unadjusted mortality rates by urban–rural county type: (a) intentional firearm and intentional nonfirearm, (b) firearm suicide and homicide, (c) nonfirearm suicide and homicide.

FIGURE 1—

Unadjusted mortality rates by urban–rural county type: (a) intentional firearm and intentional nonfirearm, (b) firearm suicide and homicide, (c) nonfirearm suicide and homicide.

FIGURE 1—

Unadjusted mortality rates by urban–rural county type: (a) intentional firearm and intentional nonfirearm, (b) firearm suicide and homicide, (c) nonfirearm suicide and homicide.

FIGURE 2—

Regression-adjusted firearm relative risks and 95% confidence intervals by county type: (a) firearm suicide and homicide, (b) firearm suicide, (c) firearm homicide.

FIGURE 2—

Regression-adjusted firearm relative risks and 95% confidence intervals by county type: (a) firearm suicide and homicide, (b) firearm suicide, (c) firearm homicide.

FIGURE 2—

Regression-adjusted firearm relative risks and 95% confidence intervals by county type: (a) firearm suicide and homicide, (b) firearm suicide, (c) firearm homicide.

FIGURE 3—

Regression-adjusted nonfirearm relative risks and 95% confidence intervals by county type: (a) nonfirearm suicide and homicide, (b) nonfirearm suicide, (c) nonfirearm homicide.

FIGURE 3—

Regression-adjusted nonfirearm relative risks and 95% confidence intervals by county type: (a) nonfirearm suicide and homicide, (b) nonfirearm suicide, (c) nonfirearm homicide.

FIGURE 3—

Regression-adjusted nonfirearm relative risks and 95% confidence intervals by county type: (a) nonfirearm suicide and homicide, (b) nonfirearm suicide, (c) nonfirearm homicide.