Kellermann A L, Rivara F P, Somes G, Reay D T, Francisco J, Banton J G, Prodzinski J, Fligner C, Hackman B B
Department of Medicine, University of Tennessee, Memphis.
N Engl J Med. 1992 Aug 13;327(7):467-72. doi: 10.1056/NEJM199208133270705.
It has been suggested that limiting access to firearms could prevent many suicides, but this belief is controversial. To assess the strength of the association between the availability of firearms and suicide, we studied all suicides that took place in the homes of victims in Shelby County, Tennessee, and King County, Washington, over a 32-month period.
For each suicide victim (case subject), we obtained data from police or the medical examiner and interviewed a proxy. Their answers were compared with those of control subjects from the same neighborhood, matched with the victim according to sex, race, and age range. Crude and adjusted odds ratios were calculated with matched-pairs methods.
During the study period, 803 suicides occurred in the two counties, 565 of which (70 percent) took place in the home of the victim. Fifty-eight percent (326) of these suicides were committed with a firearm. After excluding 11 case subjects for various reasons, we were able to interview 80 percent (442) of the proxies for the case subjects. Matching controls were identified for 99 percent of these subjects, producing 438 matched pairs. Univariate analyses revealed that the case subjects were more likely than the controls to have lived alone, taken prescribed psychotropic medication, been arrested, abused drugs or alcohol, or not graduated from high school. After we controlled for these characteristics through conditional logistic regression, the presence of one or more guns in the home was found to be associated with an increased risk of suicide (adjusted odds ratio, 4.8; 95 percent confidence interval, 2.7 to 8.5).
Ready availability of firearms is associated with an increased risk of suicide in the home. Owners of firearms should weigh their reasons for keeping a gun in the home against the possibility that it might someday be used in a suicide.
有人认为限制枪支获取可预防许多自杀行为,但这一观点存在争议。为评估枪支可获取性与自杀之间关联的强度,我们研究了田纳西州谢尔比县和华盛顿州金县在32个月期间发生在受害者家中的所有自杀事件。
对于每例自杀受害者(病例对象),我们从警方或法医处获取数据,并对一名代理人进行访谈。将他们的回答与来自同一社区、根据性别、种族和年龄范围与受害者匹配的对照对象的回答进行比较。采用配对方法计算粗比值比和调整后比值比。
在研究期间,两县共发生803起自杀事件,其中565起(70%)发生在受害者家中。这些自杀事件中有58%(326起)是使用枪支实施的。因各种原因排除11例病例对象后,我们能够对80%(442例)病例对象的代理人进行访谈。为其中99%的对象确定了匹配对照,形成438对匹配对。单因素分析显示,病例对象比对照对象更有可能独居、服用过处方精神药物、被捕、滥用药物或酒精,或未高中毕业。在通过条件逻辑回归对这些特征进行控制后,发现家中有一支或多支枪与自杀风险增加相关(调整后比值比为4.8;95%置信区间为2.7至8.5)。
枪支的随时可获取性与家中自杀风险增加相关。枪支所有者应权衡在家中保留枪支的理由与枪支有朝一日可能被用于自杀的可能性。