Deborah R. Azrael

Firearm availability and unintentional firearm deaths, suicide, and homicide among 5-14 year olds.

BACKGROUND In the United States, only motor vehicle crashes and cancer claim more lives among children than do firearms. This national study attempts to determine whether firearm prevalence is related to rates of unintentional firearm deaths, suicides, and homicides among children. METHODS Pooled cross-sectional time-series data (1988-1997) were used to estimate the association between the rate of violent death among 5-14 year olds and four proxies of firearm availability, across states and regions. RESULTS A statistically significant association exists between gun availability and the rates of unintentional firearm deaths, homicides, and suicides. The elevated rates of suicide and homicide among children living in states with more guns is not entirely explained by a states poverty, education, or urbanization and is driven by lethal firearm violence, not by lethal non-firearm violence. CONCLUSION A disproportionately high number of 5-14 year olds died from suicide, homicide, and unintentional firearm deaths in states and regions where guns were more prevalent.

Opioid analgesics and the risk of fractures in older adults with arthritis.

OBJECTIVES: To compare the risk of fracture associated with initiating opioids with that of nonsteroidal anti‐inflammatory drugs (NSAIDs) and the variation in risk according to opioid dose, duration of action, and duration of use.

Household firearm ownership and suicide rates in the United States.

Background. In the United States, more people kill themselves with firearms than with all other methods combined. A central question regarding the relation between firearms and suicide is whether the ready availability of firearms increases the suicide rate, rather than merely increasing the proportion of suicides from guns. Methods. We used publicly available data for the nine regions and 50 states in the United States over a 10-year period (1988–1997) to examine the association between levels of household firearm ownership and rates of suicide, firearm suicide, and non-firearm suicide by age groups and gender. Results. In both regional and state-level analyses, for the U.S. population as a whole, for both males and females, and for virtually every age group, a robust association exists between levels of household firearm ownership and suicide rates. Conclusions. Where firearm ownership levels are higher, a disproportionately large number of people die from suicide.

Rates of Household Firearm Ownership and Homicide Across US Regions and States, 1988–1997

OBJECTIVES In this study we explored the association between rates of household firearm ownership and homicide across the United States, by age groups. METHODS We used cross-sectional time-series data (1988-1997) to estimate the association between rates of household firearm ownership and homicide. RESULTS In region- and state-level analyses, a robust association between rates of household firearm ownership and homicide was found. Regionally, the association exists for victims aged 5 to 14 years and those 35 years and older. At the state level, the association exists for every age group over age 5, even after controlling for poverty, urbanization, unemployment, alcohol consumption, and nonlethal violent crime. CONCLUSIONS Although our study cannot determine causation, we found that in areas where household firearm ownership rates were higher, a disproportionately large number of people died from homicide.

The US gun stock: results from the 2004 national firearms survey

Objectives: To examine the size and composition of the privately held firearm stock in the US; and to describe demographic patterns of firearm ownership and motivations for ownership. Design, setting and participants: A nationally representative household telephone survey of 2770 adults aged ⩾18 years living in the US, conducted in the spring of 2004. Main outcome measure: Responses to questions regarding firearm ownership, the number and types of guns owned, and motivations for ownership. Results: 38% of households and 26% of individuals reported owning at least one firearm. This corresponds to 42 million US households with firearms, and 57 million adult gun owners. 64% of gun owners or 16% of American adults reported owning at least one handgun. Long guns represent 60% of the privately held gun stock. Almost half (48%) of all individual gun owners reported owning ⩾4 firearms. Men more often reported firearm ownership, with 45% stating that they personally owned at least one firearm, compared with 11% for women. Conclusions: The US population continues to contain at least one firearm for every adult, and ownership is becoming increasingly concentrated. Long guns are the most prevalent type of gun in the US but handgun ownership is widespread. Ownership demographic patterns support findings of previous studies.

The association between changes in household firearm ownership and rates of suicide in the United States, 1981–2002

Objective: To explore whether recent declines in household firearm prevalence in the United States were associated with changes in rates of suicide for men, women, and children. Methods: This time series study compares changes in suicide rates to changes in household firearm prevalence, 1981–2002. Multivariate analyses adjust for age, unemployment, per capita alcohol consumption, and poverty. Regional fixed effects controlled for cross sectional, time invariant differences among the four census regions. Standard errors of parameter estimates are adjusted to account for serial autocorrelation of observations over time. Results: Over the 22 year study period household firearm ownership rates declined across all four regions. In multivariate analyses, each 10% decline in household firearm ownership was associated with significant declines in rates of firearm suicide, 4.2% (95% CI 2.3% to 6.1%) and overall suicide, 2.5% (95% CI 1.4% to 3.6%). Changes in non-firearm suicide were not associated with changes in firearm ownership. The magnitude of the association between changes in household firearm ownership and changes in rates of firearm and overall suicide was greatest for children: for each 10% decline in the percentage of households with firearms and children, the rate of firearm suicide among children 0–19 years of age dropped 8.3% (95% CI 6.1% to 10.5%) and the rate of overall suicide dropped 4.1% (2.3% to 5.9%). Conclusion: Changes in household firearm ownership over time are associated with significant changes in rates of suicide for men, women, and children. These findings suggest that reducing availability to firearms in the home may save lives, especially among youth.

Cancer and the Risk of Suicide in Older Americans

PURPOSE To determine whether the risk of suicide is greater among patients with cancer than among patients with other medical illnesses. PATIENTS AND METHODS A case-control study of the suicide risk associated with medical illness among older Americans that used healthcare utilization data linked to prescription and mortality files. The patient population was comprised of 1,408 New Jersey residents age 65 years or older who were enrolled in Medicare and in a pharmaceutical insurance program. Patient cases (n = 128) died as a result of suicide during the study period of 1994 to 2002. Control patients (n = 1,280) were frequency-matched to patient cases on age and sex. Data were analyzed by using the odds ratio (OR) of suicide adjusted for age, sex, ethnicity, medical and psychiatric comorbidity, and use of prescription medications. RESULTS In adjusted analyses, the only medical condition that remained associated with suicide was cancer (OR, 2.3; 95% CI, 1.1 to 4.8). Suicide also remained associated with a diagnosis of affective disorder (OR, 2.3; 95% CI, 1.3 to 4.2), anxiety/personality disorder (OR, 2.2; 95% CI, 1.3 to 3.6), treatment with antidepressants (OR, 2.0; 95% CI, 1.2 to 3.2), and treatment with opioid analgesics (OR, 1.6; 95% CI, 1.0 to 2.5). CONCLUSION The risk of suicide in older adults is higher among patients with cancer than among patients with other medical illnesses, even after psychiatric illness and the risk of dying within a year were accounted for.

Suicide Mortality in the United States: The Importance of Attending to Method in Understanding Population-Level Disparities in the Burden of Suicide

Suicide mortality varies widely across age, sex, race, and geography, far more than does mortality from the leading causes of natural death. Unlike the tight correlation between cancer mortality and the incidence of cancer, suicide mortality is only modestly correlated with the incidence of suicidal acts and other established risk factors for suicidal behavior, such as major psychiatric disorders. An implication of this modest correlation is that the proportion of all suicidal acts that prove fatal (the case fatality ratio) must account for a substantial portion of the (nonrandom) variation observed in suicide mortality. In the United States, the case fatality ratio is strongly related to the availability of household firearms. Findings from ecologic and individual-level studies conducted over the past two decades illustrate the importance of accounting for the availability of highly lethal suicide methods in efforts to understand (and ultimately reduce) disparities in suicide mortality across populations.

Risk factors for hip fracture in US men aged 40 through 75 years.

Relatively few studies have examined risk factors for hip fracture among men. This study analyzes data from the Health Professionals Follow-up Study, a prospective study of approximately 50,000 men who were between the ages of 40 and 75 years in 1986. Body mass index, smoking status, and alcohol consumption were not associated with hip fracture in this population. However, age and height were related to hip fracture. Men who were 65 and older had a significantly higher risk of sustaining a hip fracture than younger adults. Men 6 feet or taller were more than twice as likely to sustain a hip fracture as those under 5 feet, 9 inches.

Firearm availability and suicide, homicide, and unintentional firearm deaths among women.

ContextIn the United States, more than 45,000 women died from gun violence over the last decade.ObjectiveTo determine whether measures of firearm availability are related to rates of suicide, homicide, and unintentional firearm deaths among women in the United States.DesignPooled cross-sectional time series data on suicide, homicide, and unintentional firearm deaths (1988–1997) were used to estimate the association between the rate of violent death among women and four proxies of firearm availability. Two proxies came from survey reports of household firearm ownership rates; two were derived from mortality statistics.SettingUnited States, 1988–1997.ResultsThe increased rate of suicide and homicide in states with high gun levels was accounted for primarily by significantly elevated firearm suicide and firearm homicide rates. Unintentional firearm death rates were also increased in states with more guns. At the regional level, qualitatively similar results were obtained.ConclusionBetween 1988 and 1997, the suicide, homicide, and unintentional firearm death rates among women were disproportionately higher in states where guns were more prevalent. The elevated rates of violent death in states with more guns was not entirely explained by a state’s poverty or urbanization and was driven primarily by lethal firearm violence, not by lethal nonfirearm violence.