Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
Department of Epidemiology and Biostatistics, State University of New York at Albany, Albany, New York, United States of America.
PLoS One. 2022 Jun 2;17(6):e0269372. doi: 10.1371/journal.pone.0269372. eCollection 2022.
Firearm violence remains a persistent public health threat. Comparing the impact of targeted high-risk versus population-based approaches to prevention may point to efficient and efficacious interventions. We used agent-based modeling to conduct a hypothetical experiment contrasting the impact of high-risk (disqualification) and population-based (price increase) approaches on firearm homicide in New York City (NYC).
We simulated 800,000 agents reflecting a 15% sample of the adult population of NYC. Three groups were considered and disqualified from all firearm ownership for five years, grouped based on prevalence: low prevalence (psychiatric hospitalization, alcohol-related misdemeanor and felony convictions, 0.23%); moderate prevalence (drug misdemeanor convictions, domestic violence restraining orders, 1.03%); and high prevalence (all other felony/misdemeanor convictions, 2.30%). Population-level firearm ownership was impacted by increasing the price of firearms, assuming 1% price elasticity.
In this hypothetical scenario, to reduce firearm homicide by 5% in NYC, 25% of the moderate prevalence group, or 12% of the high prevalence group needed to be effectively disqualified; even when all of the low prevalence group was disqualified, homicide did not decrease by 5%. An 18% increase in price similarly reduced firearm homicide by 5.37% (95% CI 4.43-6.31%). Firearm homicide declined monotonically as the proportion of disqualified individuals increased and/or price increased. A combined intervention that both increased price and effectively disqualified "high-risk" groups achieved approximately double the reduction in homicide as any one intervention alone. Increasing illegal firearm ownership by 20%, a hypothetical response to price increases, did not meaningfully change results.
A key takeaway of our study is that adopting high-risk versus population-based approaches should not be an "either-or" question. When individual risk is variable and diffuse in the population, "high-risk approaches" to firearm violence need to focus on relatively prevalent groups and be highly efficacious in disarming people at elevated risk to achieve meaningful reductions in firearm homicide, though countering issues of social justice and stigma should be carefully considered. Similar reductions can be achieved with population-based approaches, such as price increases, albeit with fewer such countering issues.
枪支暴力仍然是一个持续存在的公共卫生威胁。比较针对高危人群和基于人群的预防方法的效果，可能会发现更有效和有效的干预措施。我们使用基于代理的模型对纽约市（NYC）的枪支凶杀案进行了一项假设性实验，比较了高危（取消资格）和基于人群（提高价格）方法的影响。
我们模拟了 80 万名代表 NYC 成年人口 15%的样本的代理人。考虑了三组人群，并在五年内取消其所有枪支拥有权，分组依据为患病率：低患病率（精神病住院治疗、与酒精相关的轻罪和重罪定罪，0.23%）；中患病率（毒品轻罪定罪、家庭暴力限制令，1.03%）；和高患病率（所有其他重罪/轻罪定罪，2.30%）。假设价格弹性为 1%，则通过提高枪支价格来影响人群层面的枪支拥有权。
在这种假设情况下，要使 NYC 的枪支凶杀案减少 5%，需要有效取消中度患病率组的 25%，或高患病率组的 12%；即使取消了所有低患病率组，凶杀案也不会减少 5%。价格上涨 18%同样使枪支凶杀案减少 5.37%（95%CI 4.43-6.31%）。随着被取消资格的个人比例增加和/或价格上涨，枪支凶杀案呈单调下降趋势。同时提高价格和有效取消“高危”人群的联合干预措施可使凶杀案减少量达到任何单一干预措施的两倍左右。假设对价格上涨的反应是增加 20%的非法枪支拥有量，也不会显著改变结果。
我们研究的一个重要结论是，采取高危人群和基于人群的方法不应是“非此即彼”的问题。当人群中的个体风险是可变和分散的时，枪支暴力的“高危”方法需要集中于相对普遍的群体，并在使处于高风险的人失去武器方面非常有效，才能实现枪支凶杀案的有意义减少，尽管应谨慎考虑社会正义和耻辱感等问题。可以通过基于人群的方法（例如提高价格）实现类似的减少，尽管这些方法的问题较少。
