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Home » Gun control laws and firearm mortality – a public health imperative

Gun control laws and firearm mortality – a public health imperative

Let me start right at the top — gun control laws save lives. These laws prevent firearm mortality, murder, accidents, or suicide. Gun control laws should always be considered a public health issue in the USA. There have been several good epidemiological studies that have examined whether gun control regulations and firearms mortality risk are related – and the results are surprisingly robust and repeated.

From recent epidemiological research, there is some convincing evidence that establishes a correlation between state-level gun control regulations and firearms mortality rates. However, the link is not as black and white as one might wish – the relationship between gun control regulations and mortality depends on the quality of the laws. In other words, good science seems to show that gun control laws save lives.

Historically, the nation’s leading public health organization, the Centers for Disease Control and Prevention (CDC), is essentially prevented from analyzing and publishing any epidemiological research that would help us understand what, if any, links there are between gun control and firearms mortality. However, things are changing, probably because of what has been happening lately, and the CDC is funding research into firearm mortality.

Previously, because the CDC could not fund research into gun control, there has been a chilling effect on gun control research in academia. According to the Washington Post, “young academics were warned that joining the field was a good way to kill their careers. And the odd gun study that got published went through linguistic gymnastics to hide any connection to firearms.”

But maybe because this public health menace can no longer be ignored, a smattering of well-done epidemiological research is being published in very high-quality medical journals. Let’s look at one.

Photo by Maria Lysenko on Unsplash

Epidemiology of gun control laws

In March 2016, a group of researchers at Boston University, led by Dr. Bindu Kalesan, published an article in The Lancet, that examined the relationship between gun-related deaths in the US and three state gun control laws.

The researchers looked at three gun control laws (implemented in 25 gun laws in states), along with their effect on firearms mortality:

  • Firearm identification through ballistic imprinting or microstamping reduced projected mortality risk by 84%;
  • Ammunition background checks reduced risk by 82%;
  • And a universal background for all gun purchases, including those so-called loophole sales at gun shows and private transactions, reduced risk by 61%.

Furthermore,  the researchers stated that implementation of all three of these state-level gun control laws at the Federal level would reduce the national mortality rate from firearms by an estimated 10.1 per 100,000 people (using 2010 statistics) to 0.16 per 100,000. That’s a 98% absolute decrease in mortality risk – from a public health perspective, that’s like vaccines.

The researchers just didn’t pull this data out of the air. They used a cross-sectional study design, which takes observational data from one set period, in this case, after the implementation of state laws (versus before implementation).

Kalesan et al. relied upon a statistical model that determined the independent association of various firearms laws with gun-related homicides, suicides, and overall deaths. The researchers also projected the potential reduction of mortality rates if the three most effective firearms laws were enacted at the federal level using state-level data.

And even though the article by Kalesan et al. is the most recent study published in this area, other epidemiological studies have shown similar results. A study by Fleegler et al., published in 2013 in the high-impact factor journal, JAMA Internal Medicine, essentially made the same points. The authors concluded that “a higher number of firearm laws in a state are associated with a lower rate of firearm fatalities in the state, overall, and for suicides and homicides individually.”

Additionally, J John Mann and Christina A Michel of the Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York; and the Department of Psychiatry, Columbia University, New York stated that:

…(Kalesan et al.) agree with our conclusion that restricting access to firearms by those at risk for suicide is an important approach for preventing many of the more than 20,000 firearm suicides that occur annually in the United States.

One last point. The research from Kalesan et al. wasn’t funded by any organization that had a stake in the outcome. It appears to have been funded by Boston University itself, rather than by any other group.

Remember, these aren’t laws that ban weapons. They don’t infringe on the mythical Second Amendment right to own firearms. No one is asking for Gestapo agents to march into homes confiscating a hunting rifle (with apologies to Godwin’s Law). These are three simple laws that appear to be well-designed to reduce the risk of firearms deaths.

Unfortunately, if I were a gun-loving right-winger, I would cherry-pick some real and invented issues with the article.

First, the article does state some laws don’t work. Of the 25 state-level laws examined, only nine were related to reduced firearm mortality. Nine lead to increased mortality risk. And seven showed no observable correlation with increased or reduced risk.

However, the researchers did determine that the three laws mentioned above, firearm identification, background checks for ammunition, and/or universal background checks were statistically linked to lower mortality risk.

To refute the first cherry-pick, it’s clear that better gun control regulations do have an impact on reducing mortality risk.

Second, the research is a cross-sectional study that ranks below more powerful epidemiological study designs, especially case-control or cohort studies. The problem with cross-sectional studies is that they have pretty strong confounding variables (which Kalesan et al. accounted for in their analyses), and these studies use data that were gathered for other purposes.

However, this cherry-picked issue can be easily addressed. The study shows some pretty powerful reductions in mortality risk with strong statistical significance. Moreover, there aren’t a lot of variables that could impact the data – the question is rather simple, does the risk change at the point the gun control laws change? And the answer isn’t a weak yes, it’s a fairly robust and powerful yes.

And once again, Kalesan et al. didn’t publish this data alone, but in line with other epidemiological studies that support the evidence.

If gun control deniers want to bring equivalent peer-reviewed data, then do so – get it published, and maybe there can be a debate. But as far as I can tell, high-quality data that is published in high-quality journals that refute the research of Kalesan et al. is lacking.

Photo by Heather Mount on Unsplash

Other peer-reviewed articles

Since I don’t want to be accused of cherry-picking the Kalesan et al. article, let’s look at what other articles have said about the issue:

  • A systematic review (considered at the top of the hierarchy of scientific research) examined gun ownership across the world and found that homicide and suicide rates as a result of gun violence correlated with ownership.
  • An epidemiological study examined how firearm legislation correlated with firearm-related fatality rates (FFR), and conclude that “Restrictive firearm legislation is associated with decreased pediatric, unintentional, suicide, and overall FFR…”
  • A review of fatal firearm injuries to children from 2002 to 2014 concluded that “Firearm injuries are an important public health problem, contributing substantially to premature death and disability of children.” Yes, it is a public health problem.
  • A study of firearm injuries over the past decade shows that nonfatal injuries from firearms have increased across many demographic groups.
  •  Another systematic review examined the links between restrictive firearm laws and homicide rates, and they found that “The strength of firearm legislation in general, and laws related to strengthening background checks and permit-to-purchase in particular, is associated with decreased firearm homicide rates.”
  • Another systematic review examined possible methods of reducing firearms violence with better gun control laws and found that “interventions aimed at reducing gun violence should be targeted towards the most common risk factors cited in the literature such as access, violent behavioral tendencies due to past exposure or substance abuse, and mental illness including suicidal ideation.”
  • Kaufman and Richmond wrote “…public health approach positions clinicians to change the conversation from political diatribe of pro-gun and anti-gun to systematically reducing injury and death. To achieve comparable success, we must design, test, and implement effective interventions at the environmental, policy, technological, and individual levels to prevent firearm violence. We must collect robust data on firearm violence and its consequences. And we must reckon with the conditions of inequality and disadvantage that feed violence through all means.”
  • Holly et al. concluded that “gun safety programs do not improve the likelihood that children will not handle firearms in an unsupervised situation.” In other words, it’s going to take more than teaching kids how to use firearms to prevent violence.

That’s just a handful of the over 1,600 separate peer-reviewed articles that examine the epidemiology of firearms mortality. I could not find one that said “firearm legislation has no relationship to firearm mortality.” But I guess we can cherry-pick the NRA-supported criticisms of Kalesan et al. which are mostly based on rhetorical arguments and not scientific credibility. But one of the important aspects of real science is that we examine the highest quality scientific research and then determine what consensus it might support.

But like every pseudoscientist in the world, the pro-gun lobby has an a priori conclusion and seeks out evidence that supports that pre-ordained belief. You know, just like what anti-vaxxers do all the time. And the pro-gun crowd rejects any science that conflicts with their faith.

woman in black jacket holding white and red happy birthday signage gun control laws
Photo by Emma Guliani on

American Medical Association

The most prestigious medical association in the USA, the American Medical Association (AMA) has written numerous times (like in 2018) to declare that “gun violence in America is a public health crisis.”

The AMA has previously characterized gun violence as a public health threat before, but its new stance on CDC public health research is new. The AMA joins 141 other USA-based medical societies and public health institutions, such as the American Academy of Family Physicians, the American College of Physicians, and the American Academy of Pediatrics in opposing the Congressional ban on CDC public health research.

“We…have a disease on our shore,” former American Academy of Family Physicians President Wanda Filer, MD, told fellow delegates. “It’s called gun violence. We need to know more about it.”


According to this new research, laws requiring background checks for both guns and ammunition were the most effective legislative means to lower the risk of firearm mortality. The study clearly shows us the “protective effect” of state laws that close loopholes in Federal law, which currently only requires criminal background checks only for guns sold through licensed firearm dealers.

Only eight states have universal background checks – California, Colorado, Connecticut, Delaware, New York, Oregon, Rhode Island, and Washington. According to this research (which didn’t include Washington, since it implemented the law after 2010), those states generally have lower risks of firearm mortality.

The CDC needs to lead this research because it is the leader in public health in the USA. It needs to be the leader, and I am so glad that it is starting to show that leadership. And, as I showed above, there is a lot of epidemiological research that is happening on gun control laws and firearms mortality. Maybe it’s not an academic dead-end anymore.

As Mann and Michel wrote regarding gun control regulations,

Many horrific, wanton, multiple homicides all over the United States over many years have not galvanized Congress into passing meaningful national gun control. It is the right thing to do. There just is not enough public support and congressional will to do that at present. Let us improve gun safety right now because that appears to have the support of most of our society.

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Michael Simpson

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