Background Checks and State to State Variation in Firearm Suicide and Homicide Rates.
Frederick H Millham
South Shore Hospital, Weymouth, MA
Objective: Firearm public policy is of interest to surgeons.
I examine the association of required background check (BG) prior to firearm purchase on the rate of change of state-specific firearm related death rates from suicide (FS) and homicide (FH) between 2014 and 2017.
Design: Retrospective cohort study employing hierarchical longitudinal mixed effects modeling with post-estimation marginal analysis, comparing FS and FH in the base year 2014 to each of three subsequent years. This method compares each state to itself thereby controlling for confounding socioeconomic differences among states. I abstracted FS and FH for each state from the CDC WISQARS database and BG requirements from publicly reported information.
Setting: The United States
Subjects: Each of the 50 United States
Interventions: Background Checks prior to firearm purchase
Main Outcome Measures: Firearm suicide and homicide rates for each state for each year 2014-2017.
Results: The 19 BG states experienced no change in FS rate (slope 4%, p=ns), while FS rate for the 31 non-BG states increased (slope 15%, p<0.001). Both FH rates increased in both BG and non-BG (slopes 30% and 43% respectively, each p value <0.001). Together, non-BC states suffered over 2,000 excess FS per year.
Conclusions: States with BG experienced stable FS rates over the past 4 years, whereas those without BG experienced significant increases in FS rate. FH rates increases in both BG and non-BG states. Surgeons who pursue advocacy roles in firearms policy should advocate for BG as a policy associated with stable FS rates but not associated with FH.
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