Violence-Related Firearm Deaths Among Residents of Metropolitan Areas and Cities—United States, 2006-2007 FREE

MMWR. 2011;60:573-578

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Violence-related firearm deaths remain an important public health concern in the United States. During 2006-2007, a total of 25,423 firearm homicides and 34,235 firearm suicides occurred among U.S. residents.¹ These national totals include 4,166 firearm homicides and 1,446 firearm suicides among youths aged 10-19 years; the rate of firearm homicides among youths slightly exceeded the rate among persons of all ages. This report presents statistics on firearm homicides and firearm suicides for major metropolitan areas and cities, with an emphasis on youths aged 10-19 years in recognition of the importance of early prevention efforts. It integrates analyses conducted by CDC in response to requests for detailed information, arising from a heightened focus on urban violence by the media, the public, and policymakers over the past year. Firearm homicides and suicides and annual rates were tabulated for the 50 largest U.S. metropolitan statistical areas (MSAs) and their central cities* for 2006-2007, using data from the National Vital Statistics System and the U.S. Census Bureau. Firearm homicide rates in approximately two thirds of the MSAs exceeded the national rate, and 86% of cities had rates higher than those of their MSAs. The youth firearm homicide rate exceeded the all-ages rate in 80% of the MSAs and in 88% of the cities. Firearm suicide rates in just over half of the MSAs were below the national rate, and 55% of cities had rates below those of their MSAs. Youth firearm suicide rates in the MSAs and cities were collectively low compared with all-ages rates. Such variations in firearm homicide and firearm suicide rates, with respect to both urbanization and age, should be considered in the continuing development of prevention programs directed at reducing firearm violence.

Comprehensive vital statistics data from the National Vital Statistics System² for 2006-2007 (the most recent available) were used to identify firearm homicides and firearm suicides among U.S. residents. Geographic codes indicating county and city of residence were used to tabulate firearm homicide and suicide counts for the 50 largest MSAs (by population rank as of mid-year 2007) and for 62 cities within these MSAs. Tabulated counts were combined with U.S. Census Bureau population estimates for MSAs and cities to calculate annual firearm homicide and firearm suicide rates for persons of all ages (but excluding persons aged <10 years for suicides because intent to inflict self-harm is not typically attributed to young children). Rates were similarly calculated for youths aged 10-19 years. The all-ages rates were age-adjusted to the year 2000 U.S. standard age profile.

To facilitate broader geographic assessment, MSAs were classified by region (Midwest, Northeast, South, and West) as defined by the U.S. Census Bureau. Three MSAs cross regional boundaries; these MSAs were assigned to the region including their largest city.

MSA-level and city-level statistics involving firearm homicide or firearm suicide counts <20 are not reported individually because of concerns related to statistical reliability and data confidentiality. However, such data were included in composite rate calculations for all MSAs and all cities combined.

The firearm homicide rate in the 50 largest MSAs collectively was 5.2 per 100,000 persons per year, and 66% of these MSAs (33 of 50) had rates exceeding the national rate of 4.2. The central cities within these MSAs collectively had an annual all-ages firearm homicide rate of 9.7, and 86% of these cities (48 of 56 cities with reportable all-ages firearm homicide statistics) had rates exceeding those of their MSAs. The youth firearm homicide rate was 6.8 for the 50 largest MSAs combined, and exceeded the all-ages rate in 80% of MSAs (33 of 41 MSAs with reportable youth firearm homicide statistics). The central cities collectively had a youth firearm homicide rate of 14.6; the youth rate exceeded the all-ages rate in 88% of cities (28 of 32 cities with reportable youth statistics). Males accounted for more than 85% of firearm homicides (all ages) nationally and for all MSAs collectively.

Although firearm homicide rates tended to be higher with increasing urbanization and among youth relative to persons of all ages, this was not the finding for firearm suicide rates. The 50 largest MSAs collectively had an annual all-ages firearm suicide rate of 5.0 per 100,000 persons aged ≥10 years, and 52% of these MSAs (26 of 50) had rates lower than the national rate of 6.5. Central cities within these MSAs collectively had an annual all-ages firearm suicide rate of 4.7, and 55% of these cities (27 of 49 cities with reportable all-ages firearm suicide statistics) had rates lower than those of their MSAs. Youth firearm suicide rates were comparatively low, with a composite rate of 1.3 for the 50 largest MSAs and an identical composite rate of 1.3 for their central cities. Males accounted for more than 87% of firearm suicides (ages ≥10 years) nationally and for all MSAs collectively.

Notable patterns by geographic region were observed. All-ages firearm homicide rates generally were higher for MSAs in the Midwest (seven of 10 above the median MSA rate of 5.4) and South (13 of 21 above the median rate) than for MSAs in the Northeast (six of seven below the median rate) and West (eight of 12 below the median rate). All-ages firearm suicide rates were generally higher for MSAs in the South (15 of 21 at or above the median MSA rate of 6.3) than for MSAs in the Northeast (six of seven below the median rate), Midwest (six of 10 at or below the median rate), and West (seven of 12 below the median rate); the highest rates were concentrated in the South and West.

Scott R. Kegler, PhD, Joseph L. Annest, PhD, Marcie-jo Kresnow, MS, Office of Statistics and Programming; James A. Mercy, PhD, Div of Violence Prevention, National Center for Injury Prevention and Control, CDC. Corresponding contributor: Scott R. Kegler, CDC, 770-488-3830, skegler@cdc.gov.

During 2006-2007, firearm suicide and firearm homicide were the fourth and fifth leading causes of injury death in the United States, respectively.¹ For youths aged 10-19 years, firearm homicide was the second leading cause and firearm suicide was the fifth leading cause of injury death nationally.¹ The statistics presented in this report indicate that firearm homicide rates were higher and firearm suicide rates were lower among residents of the 50 largest MSAs compared with the nation as a whole; residents of these MSAs represented 54% of the U.S. population during 2006-2007, but accounted for 67% of firearm homicides and 41% of firearm suicides nationally. Similarly, for youths aged 10-19 years, residents of these MSAs accounted for 73% of firearm homicides and 39% of firearm suicides nationally. More than 85% of violence-related firearm deaths occurred among males, both nationally and for the 50 largest MSAs collectively.

Firearm homicide and suicide rates for MSAs varied substantially within and across regions. Central cities frequently had firearm homicide rates at least twice as high as those for their MSAs, but often had firearm suicide rates below those of their MSAs. The latter finding is consistent with previous findings for the United States showing that overall suicide rates generally decrease with increasing population density; this has been attributed largely to decreasing firearm suicide rates with increasing urbanization.³

The findings in this report are subject to at least three limitations. First, nonfatal firearm assault and self-harm statistics could not be provided because corresponding population-based data are not available for MSAs or cities. Second, although statistics for youths aged 10-19 years indicate the seriousness of youth violence, other age groups not considered in this report had higher firearm homicide and suicide rates (e.g., persons aged 20-29 years for firearm homicide and persons aged ≥75 years for firearm suicide). Finally, firearm homicide and suicide statistics for some cities within the 50 largest MSAs (including Orlando, Providence, Hartford, Birmingham, and Salt Lake City) could not be reported because their defined geographic codes do not appear in the vital statistics data used for the analysis.

Finding ways to prevent firearm injuries is a challenge for metropolitan areas throughout the United States. Gun violence historically has been a problem in cities, and youths have been affected disproportionately. A concerted effort has been under way during the past few decades to build the evidence base for youth violence prevention, and a number of effective strategies are now available for preventing behaviors that underlie firearm violence involving youths. These strategies include programs that (1) enhance youth skills and motivation to behave nonviolently and resolve conflicts peacefully, (2) promote positive relationships between youth and adults (e.g., parenting and mentoring programs), and (3) influence the social, environmental, and economic characteristics of schools, workplaces, and neighborhoods in ways that can reduce the likelihood of youth violence (e.g., encouraging social connectedness and facilitating economic opportunities).⁴† In addition, new approaches are being tried and tested, such as CeaseFire, which seeks to prevent street violence, particularly shootings, through outreach, conflict mediation, and the changing of community norms that support violence.⁵

Proposed measures for directly reducing the risk for firearm homicide and firearm suicide have included behavior-oriented approaches such as education regarding the safe storage and handling of guns,^6- 7 strategies to change the design of firearms to make them safer,⁸ and legislative efforts to reduce the potential for firearm-related violence (e.g., licensing requirements and waiting periods to reduce the potential consequences of impulsive suicidal behavior).⁹ However, most of these direct measures have not been evaluated adequately, making it difficult to know their effectiveness in reducing firearm-related deaths and injuries.¹⁰ Progress in preventing firearm violence will require further investigation of the effectiveness of such proposed measures, as well as building the capacity of states and communities to successfully implement programs focused on reducing all forms of interpersonal and self-directed violence.

Firearm-related suicides and homicides were the fourth and fifth leading causes of injury death in the United States during 2006-2007, together accounting for approximately 30,000 fatalities each year. Nationally, the firearm homicide rate among youths aged 10-19 years slightly exceeded the rate for persons of all ages.

What is added by this report?

Compared with the national rate of 4.2 per 100,000 persons per year, firearm homicide rates generally were higher for large metropolitan statistical areas (MSAs), with a rate of 5.2 overall; the highest rates were in central cities. Youth firearm homicide rates exceeded all-ages rates in many MSAs and cities. In contrast, firearm suicide rates were not higher in MSAs and cities than for the nation as a whole, and rates among youth were lower than for all ages combined.

What are the implications for public health practice?

National and state prevention programs directed at reducing firearm violence should focus on youths, particularly in central cities, to reduce the burden of firearm-related mortality in the United States. Initiatives designed to reduce violent deaths in urban areas can draw upon a growing evidence base for effectively addressing behaviors that underlie violence involving youths.

*An MSA is defined by the U.S. Office of Management and Budget as “a core area containing a substantial population nucleus, together with adjacent communities.” The central cities referred to in this report generally comprise the core areas.

†Additional information available at http://www.cdc.gov/violenceprevention/stryve/index.html and http://www.thecommunityguide.org/violence/schoolbasedprograms.html.