Mona A. Wright

Mortality among Recent Purchasers of Handguns

BACKGROUND There continues to be considerable controversy over whether ownership of a handgun increases or decreases the risk of violent death. METHODS We conducted a population-based cohort study to compare mortality among 238,292 persons who purchased a handgun in California in 1991 with that in the general adult population of the state. The observation period began with the date of handgun purchase (15 days after the purchase application) and ended on December 31, 1996. The standardized mortality ratio (the ratio of the number of deaths among handgun purchasers to the number expected on the basis of age- and sex-specific rates among adults in California) was the principal outcome measure. RESULTS In the first year after the purchase of a handgun, suicide was the leading cause of death among handgun purchasers, accounting for 24.5 percent of all deaths and 51.9 percent of deaths among women 21 to 44 years old. The increased risk of suicide by any method among handgun purchasers (standardized mortality ratio, 4.31) was attributable entirely to an excess risk of suicide with a firearm (standardized mortality ratio, 7.12). In the first week after the purchase of a handgun, the rate of suicide by means of firearms among purchasers (644 per 100,000 person-years) was 57 times as high as the adjusted rate in the general population. Mortality from all causes during the first year after the purchase of a handgun was greater than expected for women (standardized mortality ratio, 1.09), and the entire increase was attributable to the excess number of suicides by means of a firearm. As compared with the general population, handgun purchasers remained at increased risk for suicide by firearm over the study period of up to six years, and the excess risk among women in this cohort (standardized mortality ratio, 15.50) remained greater than that among men (standardized mortality ratio, 3.23). The risk of death by homicide with a firearm was elevated among women (standardized mortality ratio at one year, 2.20; at six years, 2.01) but low among men (standardized mortality ratio at one year, 0.84; at six years, 0.79). CONCLUSIONS The purchase of a handgun is associated with a substantial increase in the risk of suicide by firearm and by any method; the increase in the risk of suicide by firearm is apparent within a week after the purchase of a handgun. The magnitude of the increase and the relation between handgun purchase and the risk of death by homicide differ between men and women.

Drowning in childhood and adolescence: a population-based study.

We present the results of a residence-based study of drownings among Sacramento County, California children and adolescents ages 0-19 years for the years 1974-84. Children ages 1-3 had the highest drowning rates. The majority of drownings in this group, and one-third of all drownings in the study, occurred in residential swimming pools. Males ages 15-19 had a high drowning rate as well; at least 38 per cent of drownings in that age group were alcohol-associated. The implications for preventive efforts are discussed.

Effectiveness of denial of handgun purchase to persons believed to be at high risk for firearm violence.

OBJECTIVES The purpose of this study was to determine whether denial of handgun purchase is an effective violence prevention strategy. METHODS Individuals denied handgun purchase because of a prior felony conviction and handgun purchasers with a felony arrest at time of purchase were examined. RESULTS Relative to those denied purchase, handgun purchasers were found to be at greater risk for subsequent offenses involving a gun (relative risk [RR] = 1.21, 95% confidence interval [CI] = 1.08, 1.36) or violence (RR = 1.24, 95% CI = 1.11, 1.39), after adjustment for number of prepurchase weapon/violence charges. CONCLUSIONS Denial of handgun purchase to persons with a prior felony conviction may lower their rate of subsequent criminal activity.

Initial and subsequent hospital costs of firearm injuries

OBJECTIVE To provide economic, epidemiologic, and clinical data on initial and subsequent hospitalizations for firearm injuries. DESIGN Nonconcurrent prospective study; data obtained by medical records review. SETTING Public university teaching hospital, designated a level I trauma center. SUBJECTS Two hundred fifty persons first hospitalized for firearm injuries at UC Davis Medical Center, Sacramento, between January 1, 1984, and June 30, 1985, and followed by medical records review to June 30, 1989. RESULTS The aggregate hospital charge for 250 firearm injuries, exclusive of professional fees, was

Association between handgun purchase and mortality from firearm injury.

3,745,496, of which 80% was borne directly or indirectly by public funds. The charge for initial hospitalizations was

Alcohol and drowning: an analysis of contributing factors and a discussion of criteria for case selection

3,297,506. Mean and median initial charges per case were

Risk factors among handgun retailers for frequent and disproportionate sales of guns used in violent and firearm related crimes

13,190 and

Evaluation of the Think First head and spinal cord injury prevention program.

5,996 respectively; range,

The epidemiology of drowning in adulthood: Implications for prevention

787-

Death resulting from motor vehicle immersions: the nature of the injuries, personal and environmental contributing factors, and potential interventions

494,152. The five patients with charges over