Incidence, Distribution, and Lethality of Firearm Injuries in California From 2005 to 2015

Spitzer, Sarabeth A.; Pear, Veronica A.; McCort, Christopher D.; Wintemute, Garen J.

doi:10.1001/jamanetworkopen.2020.14736

Cited by 17 publications

(8 citation statements)

References 18 publications

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“…24 Firearms are associated with a particularly high case fatality ratio compared to poisonings and other methods of suicide, and therefore, warrant further inspection of their influence on physician suicide. 25 Our study found that firearms were the most commonly used lethal method by all physicians and surgeons. A recent 2020 study found that firearm ownership was associated with substantially elevated risk of suicide by firearm, with hazard ratios of 7.82 for men and 35.15 for women.…”

Section: Discussionmentioning

confidence: 69%

Factors Influencing US Physician and Surgeon Suicide Rates 2003 to 2017

et al. 2020

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Background and Objectives: With the rate of physician suicide increasing, more research is needed to implement adequate prevention interventions. This study aims to identify trends and patterns in physician/surgeon suicide and the key factors influencing physician suicide. We hope such information can highlight areas for targeted interventions to decrease physician suicide. Methods: Review of Centers for Disease Control and Preventions National Violent Death Reporting System (NVDRS) for 2003 to 2017 of physician and dentists dying by suicide. Twenty-eight medical, surgical, and dental specialties were included. Results: Nine hundred five reported suicides were reviewed. Physician suicides increased from 2003 to 2017. Majority surgeons' suicides were middle-aged, White males. Orthopedic surgeons had the highest prevalence of suicide among surgical fields (28.2%). Black/African American surgeons were 56% less likely [odds ratio (OR) = 0.44, 95% confidence interval (CI): 0.06-3.16] and Asian/Pacific Islander were 438% more likely (OR = 5.38, 95% CI: 2.13-13.56) to die by suicide. Surgeons were 362% more likely to have a history of a mental disorder (OR = 4.62, 95% CI: 2.71-7.85), were 139% more likely to use alcohol (OR = 2.39, 95% CI: 1.36-4.21), and were 289% more likely to have experienced civil/legal issues (OR = 3.89, 95% CI: 1.36-11.11). Conclusions: The prevalence of physician suicide increased over the 2003 to 2017 time-frame with over a third of deaths occurring from 2015 to 2017. Among surgeons, orthopedics has the highest prevalence of reported suicide. Risk factors for surgeon suicide include Asian/Pacific Islander race/ethnicity, older age, history of mental disorder, alcohol use, and civil/legal issues.

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Section: Discussionmentioning

confidence: 69%

Factors Influencing US Physician and Surgeon Suicide Rates 2003 to 2017

et al. 2020

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“…County-level denominators came from annual American Community Survey (ACS) population data. 15 To maximize exchangeability, we included county-level factors associated with firearm violence, identified a priori based on prior studies, [16][17][18][19] in the synthetic control model. These included percentage of residents aged 15 to 24 years and 55 years and older; percentage Hispanic, non-Hispanic Black, and non-Hispanic White residents; and percentage men; nonfirearm violent crime and property crime rates per 1000 residents; handgun sales per 1000 residents; unemployment in the civilian population aged 16 years and older; and urbanicity (eMethods in the Supplement).…”

Section: Data and Measuresmentioning

confidence: 99%

Firearm Violence Following the Implementation of California’s Gun Violence Restraining Order Law

et al. 2022

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IMPORTANCECalifornia's gun violence restraining order (GVRO) law, implemented beginning in 2016, allows for people at high risk of harming themselves or others with a firearm to be temporarily disarmed and prevented from purchasing firearms for 3 weeks to 1 year; many states have recently enacted similar laws. The research to date is on older and more limited risk-warrant laws. OBJECTIVETo determine whether implementation of the California GVRO law was associated with decreased rates of firearm assault or firearm self-harm in a large metropolitan county between 2016 and 2019. DESIGN, SETTING, AND PARTICIPANTS This serial cross-sectional study including data from 28 counties used the synthetic control method to evaluate differences in firearm violence between San Diego County and its synthetic control following implementation of the California law from 2016 to 2019. San Diego County was used as the treated unit because it issued substantially more GVROs than any other county in California during the study period. A total of 27 California counties that issued no or very few gun violence restraining orders from 2016 to 2019 and that had stable rates of firearm violence between 2005 and 2015 were included in the control pool. Data were analyzed from February 2021 to July 2021. EXPOSURES Implementation of the statewide GVRO law in 2016 in San Diego County. MAIN OUTCOMES AND MEASURESAnnual rates of fatal and nonfatal firearm assault injuries and firearm self-harm injuries per 100 000 people. RESULTSIn the study period, there were 355 GVROs in San Diego county, and a median (IQR) total of 8 (3-20) GVROs per donor county. The mean difference between the observed rate in San Diego County and the estimated rate in the synthetic San Diego County, 2016-2019, was −0.74 firearm assaults per 100 000 (−13% difference) and 0.13 firearm self-harm injuries per 100 000 (3% difference). Results from in-space placebo tests suggested that these differences cannot be distinguished from variation due to chance (pseudo-P values from a 1-sided test: P for assault = .35, P for self-harm = .67). CONCLUSIONS AND RELEVANCETo our knowledge, this study was the first to analyze the association between GVRO implementation and firearm violence in California and the first to evaluate the association between risk-based firearm removal laws and firearm assault in any state. GVROs were not associated with reduced population-level rates of firearm violence in San DiegoCounty, but this may change as the number of orders increases over time; the association between GVROs and firearm violence at the individual level cannot be inferred from our findings and should be the subject of future studies.

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“…Handgun acquisition has been associated with large increases in firearm suicide risk, with a hazard ratio of nearly 8 among men and over 35 among women (Studdert et al 2020 ). Despite this purchasing surge and the high lethality of firearm suicide attempts (Conner et al 2019 ; Spitzer et al 2020 ), few studies have examined pandemic-era trends in firearm suicide specifically, and none have looked at California, the most populous and diverse state in the USA.…”

Section: Introductionmentioning

confidence: 99%

Changes in suicide in California from 2017 to 2021: a population-based study

et al. 2023

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Background Suicide is a major public health problem with immediate and long-term effects on individuals, families, and communities. In 2020 and 2021, stressors wrought by the COVID-19 pandemic, stay-at-home mandates, economic turmoil, social unrest, and growing inequality likely modified risk for self-harm. The coinciding surge in firearm purchasing may have increased risk for firearm suicide. In this study, we examined changes in counts and rates of suicide in California across sociodemographic groups during the first two years of the COVID-19 pandemic relative to prior years. Methods We used California-wide death data to summarize suicide and firearm suicide across race/ethnicity, age, education, gender, and urbanicity. We compared case counts and rates in 2020 and 2021 with 2017–2019 averages. Results Suicide decreased overall in 2020 (4123 deaths; 10.5 per 100,000) and 2021 (4104; 10.4 per 100,000), compared to pre-pandemic (4484; 11.4 per 100,000). The decrease in counts was driven largely by males, white, and middle-aged Californians. Conversely, Black Californians and young people (age 10 to 19) experienced increased burden and rates of suicide. Firearm suicide also decreased following the onset of the pandemic, but relatively less than overall suicide; as a result, the proportion of suicides that involved a firearm increased (from 36.1% pre-pandemic to 37.6% in 2020 and 38.1% in 2021). Females, people aged 20 to 29, and Black Californians had the largest increase in the likelihood of using a firearm in suicide following the onset of the pandemic. The proportion of suicides that involved a firearm in 2020 and 2021 decreased in rural areas compared to prior years, while there were modest increases in urban areas. Conclusions The COVID-19 pandemic and co-occurring stressors coincided with heterogeneous changes in risk of suicide across the California population. Marginalized racial groups and younger people experienced increased risk for suicide, particularly involving a firearm. Public health intervention and policy action are necessary to prevent fatal self-harm injuries and reduce related inequities.

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Incidence, Distribution, and Lethality of Firearm Injuries in California From 2005 to 2015

Cited by 17 publications

References 18 publications

Factors Influencing US Physician and Surgeon Suicide Rates 2003 to 2017

Factors Influencing US Physician and Surgeon Suicide Rates 2003 to 2017

Firearm Violence Following the Implementation of California’s Gun Violence Restraining Order Law

Changes in suicide in California from 2017 to 2021: a population-based study

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