Firearms mortality, either murder, accidental or suicide, has always been 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 vigorous.
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 firearms regulations and mortality depends on the quality of the law.
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. The Republican dominated congress have done everything they can to prevent the CDC from using any funds to study the issue.
Furthermore, because the CDC cannot (or will not) fund research into gun control, it has lead to 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.
Epidemiology of gun control regulations
In March 2016, a group of researchers at Boston University, lead 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 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 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 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 of time, in this case, after implementation of state laws (versus prior to 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. In fact, 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 rights to own guns. 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.
Cherry picking the bad parts
If I were a gun loving right winger, I would find 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 firearms mortality. Nine actually 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 actually do have an impact on reducing mortality risk.
Second, the research is a cross-sectional study which 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. appeared to control), 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 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.
Other peer-reviewed articles
Since I don’t want to be accused of cherry-picking this article (the point of this post was to review Kalesan et al.), let’s look at what other articles have said about the issue:
- A systematic review (considered 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 2002-2014 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 show that non fatal 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.”
That’s just a handful of the over 1,000 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 radicals have an a priori conclusion, and seek out evidence that support that pre-ordained belief. And they reject any science that conflicts with their faith.
American Medical Association
The most prestigious medical association in the USA, the American Medical Association (AMA), has just voted (14 June 2016) to call “gun violence in the United States ‘a public health crisis’ requiring a comprehensive public health response and solution.” The AMA passed a resolution in its House of Delegates to begin to actively lobby Congress to “overturn legislation that for 20 years has prohibited the Centers for Disease Control and Prevention (CDC) from researching gun violence.”
The AMA has previously characterized gun violence as a public health threat before, but the 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,” 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 firearms mortality. The study clearly shows us the “the protective effect” of state laws that close loopholes in the 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, Washington. According to this research (which didn’t include Washington, since it implemented the law after 2010) , those states generally have lower risks of firearms mortality.
The CDC needs to be involved with this research. Remember, if this Congress can block funding for gun research, the next Congress could block the CDC from researching flu vaccines. Or Ebola viruses. Or whatever right wing or left wing crazies want.
Despite the lack of involvement of the CDC, we’re seeing very powerful epidemiological research, rather than anecdotes, misinformation, and outright lies, that support the facts that even the simplest of gun control regulations can have a profound effect on deaths from guns.
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.
Note – This article was originally published in March 2016, and has been updated with some more current information to respond to the cherry picking analysis of the pro-gun shills.
- Fleegler EW, Lee LK, Monuteaux MC, Hemenway D, Mannix R. Firearm legislation and firearm-related fatalities in the United States. JAMA Intern Med. 2013 May 13;173(9):732-40. doi: 10.1001/jamainternmed.2013.1286. PubMed PMID: 23467753.
- Fowler KA, Dahlberg LL, Haileyesus T, Gutierrez C, Bacon S. Childhood Firearm Injuries in the United States. Pediatrics. 2017 Jul;140(1). pii: e20163486. doi: 10.1542/peds.2016-3486. Epub 2017 Jun 19. PubMed PMID: 28630118.
- Kalesan B, Mobily ME, Keiser O, Fagan JA, Galea S. Firearm legislation and firearm mortality in the USA: a cross-sectional, state-level study. Lancet. 2016 Mar 10. pii: S0140-6736(15)01026-0. doi: 10.1016/S0140-6736(15)01026-0. [Epub ahead of print] PubMed PMID: 26972843.
- Kalesan B, Adhikarla C, Pressley JC, Fagan JA, Xuan Z, Siegel MB, Galea S. The Hidden Epidemic of Firearm Injury: Increasing Firearm Injury Rates During 2001-2013. Am J Epidemiol. 2017 Apr 1;185(7):546-553. doi: 10.1093/aje/kww147. PubMed PMID: 28338922.
- Lee LK, Fleegler EW, Farrell C, Avakame E, Srinivasan S, Hemenway D, Monuteaux MC. Firearm Laws and Firearm Homicides: A Systematic Review. JAMA Intern Med. 2017 Jan 1;177(1):106-119. doi: 10.1001/jamainternmed.2016.7051. Review. PubMed PMID: 27842178.
- Mann JJ, Michel CA. Improving Firearm Safety in the United States: Response to Kapusta and Cramer. Am J Psychiatry. 2017 Jan 1;174(1):78. doi: 10.1176/appi.ajp.2016.16070850r. PubMed PMID: 28041005.
- Panczak R, Geissbühler M, Zwahlen M, Killias M, Tal K, Egger M. Homicide-suicides compared to homicides and suicides: systematic review and meta-analysis. Forensic Sci Int. 2013 Dec 10;233(1-3):28-36. doi: 10.1016/j.forsciint.2013.08.017. Epub 2013 Aug 24. Review. PubMed PMID: 24314498.
- Resnick S, Smith RN, Beard JH, Holena D, Reilly PM, Schwab CW, Seamon MJ. Firearm Deaths in America: Can We Learn From 462,000 Lives Lost? Ann Surg. 2017 Sep;266(3):432-440. doi: 10.1097/SLA.0000000000002376. PubMed PMID: 28657951.
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