Research In Action
Research In Action
Ask an average American where you would be most likely to die as a result of gun violence and you would usually hear a confident “big cities” rather than “small towns” (or specifically, large counties vs. small counties). And that perception is certainly mirrored in the lay media where stories of inner-city gun violence abound. The stories of interpersonal violence are often highlighted as a prequel to discussions about the need to relax most any existing gun restrictions. But that narrative would be incorrect.
In new research from CHOP, Columbia University, and the University of California, Davis published today in JAMA Surgery, my co-authors and I found that, statistically speaking, residents in small counties are much more likely (and increasingly so) to die by gun violence than residents in the largest counties. While gun homicides predominate in the largest counties, gun suicides far outweigh their prevalence in the smaller and smaller counties as you move out of the large cities. The enormous burden of gun suicide in more rural communities make them less safe compared to the largest counties. Many legislators will cite the high crime rates and homicides present in our large cities as reason to promote ease of access to firearms for protection or encouraging concealed carry. However, constituents in the more rural counties are at much greater risk, albeit a different mechanism. In both scenarios though, ease of access plays a role in violent firearm deaths.
Using data from the multiple cause of death dataset which captures all deaths in the United States we were able to investigate firearm deaths at the county level for all 3,141 counties in the US. The counties were categorized using a rural-urban continuum scale based on population and proximity to metropolitan centers. This study built on a prior analysis we did in 2004 using the same methodology. That original study demonstrated the risk of firearm mortality was the same across the rural urban continuum. That is, you were as likely to die of firearm violence in the largest counties as the smallest counties. In this updated study, we compared the first two decades of the 21st century in ten-year blocks.
We again noted higher rates of homicide in the most urban counties and increasing rates of firearm suicides moving rurally. In the first decade, 2001-2010, the most rural county types had a 25% higher rate of firearm mortality and the most urban counties. This difference was driven by the volume of deaths and the 54% higher gun suicide rate in the rural-most counties. The rate was higher even though the firearm homicide rate was 50% lower in these same rural-most counties. By the second decade of study (2011-2020), the overall firearm death rate was up to 37% greater, and the firearm suicide rate up to 76% greater when comparing the rural-most to urban-most county types.
While the two ends of the rural spectrum offer a dramatic comparison, what is clear is that across the entire continuum, overall firearm mortality increases as one moves from urban to rural. That is, you are more likely to die from a firearm injury not in the big cities (counties) but rather the smaller, more rural counties. Thus, firearm injuries are an issue for all Americans, not just those that populate our large metropolitan centers. Legislators across the country need to work towards sensible, thoughtful gun legislation.