Comparing Risks of Firearm-Related Death and Injury Among Young Adult Males in Selected US Cities With Wartime Service in Iraq and Afghanistan

Abstract

ImportanceIn 2020, homicides in the United States saw a record single-year increase, with firearm injuries becoming the leading cause of death for children, adolescents, and young adults. It is critical to understand the magnitude of this crisis to formulate an effective response.ObjectiveTo evaluate whether young adult males living in parts of 4 major US cities faced a firearm-related death and injury risk comparable with risks encountered during recent wartime service in Iraq and Afghanistan.Design, Setting, and ParticipantsIn this cross-sectional study of young adult males aged 18 to 29 years living in the top 10% most violent zip codes in each domestic setting (as measured by fatal shooting rates), fatal and nonfatal shooting data for 2020 and 2021 were aggregated at the zip code level for 4 of the largest US cities (Chicago, Illinois; Los Angeles, California; New York, New York; and Philadelphia, Pennsylvania). Wartime mortality and combat injury rates for the conflicts in Iraq and Afghanistan were used to assess relative risk.Main Outcomes and MeasuresThe relative risk of firearm-related death and nonfatal shootings in each setting as compared with combat death and injury in the comparator setting.ResultsOf 129 826 young adult males aged 18 to 29 years living in the top 10% most violent zip codes in the 4 cities studied, 45 725 (35.2%) were Black, 71 005 (54.7%) were Hispanic, and 40 355 (31.1%) were White. Among this population, there were 470 homicides and 1684 firearm-related injuries. Young adult males living in the most violent zip code of Chicago (2585 individuals aged 20-29 y) and Philadelphia (2448 individuals aged 18-29 y) faced a higher risk of firearm-related homicide than US soldiers who were deployed to Afghanistan, with risk ratios of 3.23 (95% CI, 2.47-4.68) and 1.91 (95% CI, 1.32-3.46), respectively. In expanding the analysis to the top 10% of the cities’ most violent zip codes, the risks in Chicago likewise exceeded those of combat death faced by military service members, with a risk ratio of 2.10 (95% CI, 1.82-2.46), and the risks in Philadelphia were comparable with those of deployment to war 1.15 (95% CI, 0.98-1.39). Nonfatal shooting risks were comparable with, or exceeded, the injury risk of combat in Iraq, producing a combined annual firearm risk of 5.8% in Chicago and 3.2% in Philadelphia. However, these findings were not observed in the most violent zip codes of Los Angeles and New York City, where young men faced a 70% to 91% lower risk than soldiers in the Afghanistan war across fatal and nonfatal categories (eg, fatal shooting in most violent zip code in Los Angeles: risk ratio, 0.30; 95% CI, 0.26-0.34; nonfatal shooting in top 10% most violent zip codes in New York: risk ratio, 0.09; 95% CI, 0.08-0.10). The risk of violent death and injury observed in the zip codes studied was almost entirely borne by individuals from minoritized racial and ethnic groups: Black and Hispanic males represented 96.2% of those who were fatally shot (452 individuals) and 97.3% of those who experienced nonfatal injury (1636 individuals) across the 4 settings studied.Conclusions and RelevanceIn this cross-sectional study, for young adult men in several of the communities studied, firearm violence carried morbidity and mortality risks that exceeded those of war. Health equity requires prioritizing effective responses.

Inequalities in Exposure to Firearm Violence by Race, Sex, and Birth Cohort From Childhood to Age 40 Years, 1995-2021

“…3 Firearm deaths have now surpassed motor vehicle crashes as the leading cause of death for US children, with Black children, boys, and children from disadvantaged neighborhoods in cities like Chicago, Illinois, disproportionately impacted. [4][5][6][7] The extreme fluctuation in lethal violence in the US over the past 3 decades means that successive cohorts of children growing up and reaching adulthood in these times experienced much different social worlds, what has been called the "birth lottery of history." 8 Even if they are from the same socioeconomic status, some adults today were raised during an era of relative calm, whereas others, sometimes just a handful of years older or younger, reached their formative years of adolescence and early adulthood during epidemic levels of firearm violence.…”

“…Taking experts by surprise, homicides then began increasing before spiking in 2016 and again in 2020 . Firearm deaths have now surpassed motor vehicle crashes as the leading cause of death for US children, with Black children, boys, and children from disadvantaged neighborhoods in cities like Chicago, Illinois, disproportionately impacted …”

“… 3 Firearm deaths have now surpassed motor vehicle crashes as the leading cause of death for US children, with Black children, boys, and children from disadvantaged neighborhoods in cities like Chicago, Illinois, disproportionately impacted. 4 , 5 , 6 , 7 …”

Disaggregating Fatal and Non-Fatal Shootings in Boston, 2015-2023

“…While fatality rates for males are slightly higher than for females (17% vs 12% respectively), the overall proportions across the different demographic categories are quite stable. While shooting victimization is highly concentrated among young males in a sample of US cities 12 , fatalities following a shooting are largely due to chance. 13 Subsequently, monitoring the prevalence of shootings will provide more signals as to the efficacy of different gun violence interventions than monitoring gun deaths in isolation.…”

“I am a survivor!”: Violently Injured Black Men’s Perceptions of Labeling After a Violent Firearm Injury

“…Both ‘warrior’ and ‘casualty’ are traditionally used to describe participants of war, which also relates to how violence in concentrated places often are perceived as “battle zones” or “war zones” between individuals or groups [ 45 ], with its effects mirroring the hypervigilance, trauma, and mental/physical injuries associated with military personnel. In summation, given the small sample, these two participants with alternate labels suggest there are probably more variations identifications following firearm injury, which could be further explored among a different (e.g., geographic area, or ages, or recency injury) and/larger sample.…”