Abstract
Background
Firearm-related suicides comprise over two-thirds of gun-related violence in the United
States, and gun laws and policies remain under scrutiny, with many advocating for
revision of the regulatory map for lawful gun ownership, aiming at restricting access
and distribution of these weapons. However, the quantitative relationship between
how strict gun laws are and the incidence of firearm violence with their associated
mortality is largely unknown. We therefore, sought to explore the impact of firearm
law patterns among states on the incidence and outcomes of firearm-related suicide
attempts, utilizing established objective criteria.
Methods
The National Inpatient Sample for the years 1998-2011 was queried for all firearm-related
suicides. Discharge facilities were stratified into five categories (A, B, C, D, and
F, with A representing states with the most strict and F representing states with
the least strict laws) based on the Brady Campaign to prevent Gun Violence that assigns
scorecards for every state. The primary outcomes were suicide attempts and in-hospital
mortality per 100,000 populations by Brady state grade.
Results
During the 14-year study period, 34,994 subjects met inclusion criteria. The mean
age was 42.0 years and 80.1% were male. A handgun was utilized by 51.8% of patients.
The overall mortality was 33.3%. Overall, 22.0% had reported psychoses and 19.3% reported
depression. After adjusting for confounding factors and using group A as reference,
there were higher adjusted odds for suicide attempts for patients admitted in group
C, D, and F category states (1.73, 2.09, and 1.65, respectively, all P < 0.001).
Conclusions
Firearm-related suicide attempt injuries are more common in states with less strict
gun laws, and these injuries tend to be associated with a higher mortality. Efforts
aimed at nationwide standardization of firearm state laws are warranted, particularly
for young adults and suicide-prone populations.
Level of evidence
III.
Study type
Trauma Outcomes study.
Keywords
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Article info
Publication history
Published online: September 18, 2017
Accepted:
August 14,
2017
Received in revised form:
June 20,
2017
Received:
January 10,
2017
Identification
Copyright
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