Firearm Violence: A Public Health Issue Doug Wiebe PhD Associate - PowerPoint PPT Presentation

Firearm Violence: A Public Health Issue Doug Wiebe PhD Associate Professor Department of Biostatistics and Epidemiology Firearm & Injury Center at PENN (FICAP) Perelman School of Medicine University of Pennsylvania 9/29/14 FIREARM & INJURY CENTER AT PENN

FICAP Wharton Firearm & Leonard Davis School of Injury Center Institute of Business Criminology at Penn Health Economics Cartographic Modeling Laboratory HUP Social Policy Sociology Biostatistics CHOP Nursing Epidemiology FICAP: Interdisciplinary Research FIREARM & INJURY CENTER AT PENN

Epidemiology The study of the distribution and determinants of disease in populations, and the application of this study to the control of disease. FIREARM & INJURY CENTER AT PENN

Vector, Agent & Host in Environment FIREARM & INJURY CENTER AT PENN

Vectors FIREARM & INJURY CENTER AT PENN

Agents P. falciparum F. tularensis FIREARM & INJURY CENTER AT PENN

Environments FIREARM & INJURY CENTER AT PENN

Schwab et al, 2002 FIREARM & INJURY CENTER AT PENN

United States Firearm Death Profile, 2007 Number Rate* Total Firearm Deaths 31,224 10.3 Suicides 17,352 (56%) 5.6 Homicides 12,632 (40%) 4.2 Unintentional 613 (2%) 0.2 Legal Intervention 351 (1%) 0.1 Undetermined 276 (<1%) 0.09 *Death rate per 100,000 population. Source: National Vital Statistics Report, CDC, 2007 FIREARM & INJURY CENTER AT PENN

Firearm Suicide Rate Gender and Age – U.S. 45 40 Rate* per 100,000 population 35 Male 30 Female 25 20 15 10 5 0 . 9 4 9 4 9 4 9 4 9 4 9 4 9 4 + 4 1 2 2 3 3 4 4 5 5 6 6 7 7 8 5 1 - - - - - - - - - - - - - - 8 - 5 0 5 0 5 0 5 0 5 0 5 0 5 0 0 1 2 2 3 3 4 4 5 5 6 6 7 7 8 1 Age Source: National Center for Injury Prevention and Control, CDC *Age-adjusted rates per 100,000 population based on year 2000 standard FIREARM & INJURY CENTER AT PENN

Firearm Homicides by Age, Race, and Sex 100 Rate* per 100,000 population 80 Black Male Black 60 Female White Male 40 White Female 20 0 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 Age Source: National Vital Statistics Data, CDC *Age-adjusted rate per 100,000 U.S. standard population based on year 2000 standard. FIREARM & INJURY CENTER AT PENN

Firearms in the U.S. x 65 million x 70 million x 49 million x 8 million > 200 million FIREARM & INJURY CENTER AT PENN

5 4.47 4 4.01 Average wounds-per-gun 3 3.00 2.72 2.33 2 2.00 1 0 All Pistols Revolvers All Long- Rifles Shotguns Handguns guns FIREARM & INJURY CENTER AT PENN

FIREARM & INJURY CENTER AT PENN

Fatalities: Tip of the Iceberg Nonfatal unintentional gunshot injuries outnumber fatalities by 16:1 Nonfatal firearm assaults outnumber gun homicides by 4:1 In contrast, firearm suicide attempts result in death in approximately 85% of cases Kellermann and Waeckerle. Ann Emerg Med 1998; 32:77-79. FIREARM & INJURY CENTER AT PENN

Medical costs of gunshot injuries • 140,000 gunshot injuries in US annually • Mean medical cost per injury = $17,000 • Gunshot wounds (GSW) produce $2.3 billion in lifetime medical costs – 49% is paid by US taxpayers • Assault-related GSWs accounted for 74% of total costs FIREARM & INJURY CENTER AT PENN

Firearms in Households One in every three households contains a firearm(s) FIREARM & INJURY CENTER AT PENN

Who Owns Guns and Why? National Survey of Private Ownership of Firearms: Own Own For gun gun protection Men Men 4 in 10 4 in 10 41% Women Women 1 in 10 1 in 10 67% FIREARM & INJURY CENTER AT PENN

Q: Do you have guns at home? A: Y / N (depends on whom you ask) • When asking husband-wife pairs: 80% of husbands reported guns in the home, vs 72% of wives • Most often, the husband owned the guns Coyne-Beasley et al Pediatrics 2005 Ludwig et al Am J Public Health 1998 Azrael et al Pediatrics 2000 FIREARM & INJURY CENTER AT PENN

FIREARM & INJURY CENTER AT PENN

Homicide Deaths in 2006: Who Was Killed and How? Homicides % by Gun % by % by Intimate Intimate Using Gun Female 3,945 1,795 1,247 735 (19%) (46%) (32%) Male 12,820 9,006 440 226 (70%) (3%) (2%) Centers for Disease Control, Bureau of Justice Statistics FIREARM & INJURY CENTER AT PENN

Case-Control Study of Homicide • Method (case-control) 1. Identify Cases: persons killed (homicide) at home 2. Identify Control: living persons 3. Compare: did gun ownership differ between groups? • United States population samples National Mortality Followback Survey (cases) National Health Interview Survey (controls) • Exposure: presence of gun(s) in the home Wiebe. Annals Emerg Med 2003 Wiebe. Accid Analysis Prev 2003 FIREARM & INJURY CENTER AT PENN

Homicide: Gun in Home as Risk Factor Mortality odds ratio (95% CI) associated with having a gun in home 2.5 1.7 2 1.5 0.8 1 0.5 Killed with Killed with a gun another weapon 0 Wiebe. Annals Emerg Med 2003 FIREARM & INJURY CENTER AT PENN

Homicide Risk Significantly Higher Among Women 3 2.5 2 1.5 1 Women Men 0.5 Odds ratio (95% CI) 0 for gun in the home FIREARM & INJURY CENTER AT PENN

FIREARM & INJURY CENTER AT PENN

10 Leading Causes of Death, US 10-19 years old 1. Unintentional Injury 8,679 (Guns, 2%) 2. Homicide 2,108 (Guns, 82%) 3. Suicide 1,773 (Guns, 46%) 4. Malignant Neoplasms 1,258 5. Heart Disease 568 6. Congenital Anomalies 466 7. Chronic Low. Resp. Disease 188 8. Influenza & Pneumonia 128 9. Cerebro-vascular 111 10. Septicemia 102 Deaths from motor vehicle crash and gunshot injuries, US (all ages) 30 Cars Guns Deaths per 100,000 Deaths per 100,000 20 10 0 1968 1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 Year Year CDC MMWR 94;43(3) FIREARM & INJURY CENTER AT PENN

Motor Vehicle Crash Prevention: example of a “passive intervention” FIREARM & INJURY CENTER AT PENN

Bott’s Dots FIREARM & INJURY CENTER AT PENN

FIREARM & INJURY CENTER AT PENN

“None of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control CDC’s funds may not be spent on political action or other activities designed to affect the passage of specific Federal, State, or local legislation intended to restrict or control the purchase or use of firearms”. Kassirer JP. A partisan assault on science--the threat to the CDC. N Engl J Med 1995;333:793-4. FIREARM & INJURY CENTER AT PENN

Branas, Wiebe, Schwab, Richmond. Getting past the “f” word in federally funded public health research. Injury Prevention 2005; 11:191-192. FIREARM & INJURY CENTER AT PENN

FIREARM & INJURY CENTER AT PENN

FIREARM & INJURY CENTER AT PENN

www.uphs.upenn.edu/ficap FIREARM & INJURY CENTER AT PENN