From the Department of Surgery, Tulane University School of Medicine (A.C.H., O.J.-W., E.T., N.B., T.B., P.M., J.D., S.T.); Tulane University School of Public Health and Tropical Medicine (A.H.), New Orleans; and Our Lady of the Lake Regional Medical Center (D.T.), Baton Rouge, Louisiana.
J Trauma Acute Care Surg. 2021 Jul 1;91(1):64-71. doi: 10.1097/TA.0000000000003167.
Metropolitan cities in the United States suffer from higher rates of gun violence. However, the specific structural factors associated with increased gun violence are poorly defined. We hypothesized that firearm homicide in metropolitan cities would be impacted by Black-White segregation index.
This cross-sectional analysis evaluated 51 US metropolitan statistical areas (MSAs) using data from 2013 to 2017. Several measures of structural racism were examined, including the Brooking Institute's Black-White segregation index. Demographic data were derived from the US Census Bureau, US Department of Education, and US Department of Labor. Crime data and firearm homicide mortality rates were obtained from the Federal Bureau of Investigation and the Centers for Disease Control. Spearman ρ and linear regression were performed.
Firearm mortality was associated with multiple measures of structural racism and racial disparity, including White-Black segregation index, unemployment rate, poverty rate, single parent household, percent Black population, and crime rates. In regression analysis, percentage Black population exhibited the strongest association with firearm homicide mortality (β = 0.42, p < 0.001). Black-White segregation index (β = 0.41, p = 0.001) and percent children living in single-parent households (β = 0.41, p = 0.002) were also associated with higher firearm homicide mortality. Firearm legislation scores were associated with lower firearm homicide mortality (β = -0.20 p = 0.02). High school and college graduation rates were not associated with firearm homicide mortality and were not included in the final model.
Firearm homicide disproportionately impacts communities of color and is associated with measures of structural racism, such as White-Black segregation index. Public health interventions targeting gun violence must address these systemic inequities. Furthermore, given the association between firearm mortality and single-parent households, intervention programs for at-risk youth may be particularly effective.
Epidemiological level II.
美国的大都市区遭受着更高的枪支暴力率。然而，与枪支暴力增加相关的具体结构因素仍未得到明确界定。我们假设大都市的枪支凶杀案将受到黑白隔离指数的影响。
本横断面分析使用了 2013 年至 2017 年的数据，评估了 51 个美国大都市区统计区（MSA）。研究考察了几种结构种族主义的衡量标准，包括布鲁金斯学会的黑白隔离指数。人口统计数据来自美国人口普查局、美国教育部和美国劳工部。犯罪数据和枪支凶杀死亡率数据来自联邦调查局和疾病控制中心。进行了 Spearman ρ 和线性回归分析。
枪支死亡率与多种结构种族主义和种族差异衡量标准相关，包括白人和黑人的隔离指数、失业率、贫困率、单亲家庭、黑人人口比例和犯罪率。在回归分析中，黑人人口比例与枪支凶杀死亡率的相关性最强（β=0.42，p<0.001）。黑白隔离指数（β=0.41，p=0.001）和生活在单亲家庭的儿童比例（β=0.41，p=0.002）也与更高的枪支凶杀死亡率相关。枪支立法得分与枪支凶杀死亡率降低相关（β=-0.20，p=0.02）。高中和大学毕业率与枪支凶杀死亡率无关，未包含在最终模型中。
枪支凶杀案不成比例地影响有色人种社区，与结构种族主义的衡量标准有关，例如黑白隔离指数。针对枪支暴力的公共卫生干预措施必须解决这些系统性不平等问题。此外，鉴于枪支死亡率与单亲家庭之间的关联，针对高危青年的干预计划可能特别有效。
流行病学 II 级。
