Your neighborhood matters: an ecological social determinant study of the relationship between residential racial segregation and the risk of firearm fatalities

Abstract

Background: Firearm fatalities are a major public health concern, claiming the lives of 40,000 Americans each year. While firearm fatalities affect all, it is unclear how social determinants such as residential segregation affect firearm fatalities. To address this knowledge gap, this study investigates the relationship between residential segregation and the likelihood of firearm fatalities. Methods: Ecological county-level data for 72 Wisconsin counties from the American Community Survey (ACS) were merged with Vital Statistics System mortality records (2015-2019). The study outcome was firearm fatalities, defined as the number of deaths due to firearms per 100,000 population from 2015 to 2019 (used as a continuous variable). The independent variable was residential segregation, using the 2015-2019 ACS-Dissimilarity Index (DI), which measures the degree to which non-white and white residents are distributed across counties and ranges from 0 (complete integration) to 100 (complete segregation), with higher values indicating greater residential segregation. Confounders included income inequality (2015-2019) and community resilience (2019). Poisson regression analyses were conducted using STATA/MP-v.17.0. P-values of ≤0.05 were considered statistically significant. Results: From 2015 to 2019, there were 843 firearm fatalities. Mean (SD) residential segregation was 32.4 (13.1). Bivariate analysis indicates that an increase in residential segregation was significantly associated with increased firearm fatalities (Coef.:0.1,95%CI:0.05-0.06). Adjusted model results indicate that for every increase in residential segregation (by DI), the likelihood of firearm fatalities increased by 0.01% (Coef.:0.01,95%CI:0.007-0.02). Conclusion: Residential segregation, among other social determinants, increases the likelihood of firearm fatalities. This research helps healthcare systems-based practitioners understand how the larger social context influences gun violence disparities.