枪支立法：毗邻州与粗死亡率之间的关联。
Firearm legislation: The association between neighboring states and crude death rates.
机构信息
From Department of Surgery, Division of Trauma and Surgical Critical Care, University of Miami Miller School of Medicine/Jackson Memorial Hospital (M.C., G.D.P., J.P.M., I.A.R., R.R., N.N.), Miami, FL; Department of Public Health Sciences, Division of Biostatistics, University of Miami Miller School of Medicine (H.K.), Miami, FL; Department of Surgery, Division of Acute Care Surgery, University of Florida College of Medicine (M.C.), Jacksonville, FL; and Division of Emergency General Surgery, Department of Surgery, University of Colorado/Denver Health (D.D.Y.), Denver, CO.
出版信息
J Trauma Acute Care Surg. 2023 Jul 1;95(1):122-127. doi: 10.1097/TA.0000000000003952. Epub 2023 Mar 28.
BACKGROUND
Few studies have examined the impact of interstate differences in firearm laws on state-level firearm mortality. We aim to study the association between neighboring states' firearm legislation and firearm-related crude death rate (CDR).
METHODS
The CDC Web-based Injury Statistics Query and Reporting System was queried for adult all-intent (accidental, suicide, and homicide) firearm-related CDR among the 50 states from 2012 to 2020. States were divided into five cohorts based on the Giffords Law Center Annual Gun Law Scorecard, and two groups were constructed: Strict (A, B, C) and Lenient (D, F). We examined the effect of (1) a single incongruent neighbor, defined as "Different" if the state is bordered by ≥1 state with a grade score difference >1, and (2) the average grade of all neighboring states, defined as "Different" if the average of all neighboring states resulted in a grade score difference >1.
RESULTS
Strict states with similar average neighbors had significantly lower CDR compared with Strict states with different average neighbors (2.98 [1.91-5.06] vs. 3.87 [2.37-5.94], p = 0.02), while Lenient states with similar average neighbors had significantly higher CDR compared with Lenient states with different average neighbors (6.02 [4.56-8.11] vs. 4.7 [3.95-5.35], p = 0.002). Lenient states surrounded by all similar Lenient states had the highest CDR, which was significantly higher than Lenient states with ≥1 different neighbor (6.52 [5.09-8.96] vs. 5.19 [3.85-6.61], p < 0.001). However, Strict states with ≥1 different neighbor did not have higher CDR compared with Strict states surrounded by all similar Strict states (3.39 [2.17-5.35] vs. 3.14 [1.91-5.38], p = 0.5).
CONCLUSION
We report a lopsided neighboring effect whereby Lenient states may benefit from at least one Strict neighbor, while Strict states may be adversely affected only when surrounded by mostly Lenient neighbors. These findings may assist policymakers regarding the efficacy of their own state's legislation in the context of incongruent neighboring states.
LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level IV.
背景
很少有研究探讨州际枪支法律差异对州级枪支死亡率的影响。我们旨在研究邻近州的枪支立法与枪支相关的粗死亡率（CDR）之间的关联。
方法
从 2012 年至 2020 年，通过疾病控制与预防中心基于网络的伤害统计数据查询和报告系统，对 50 个州的所有意图（意外、自杀和凶杀）枪支相关 CDR 进行了调查。根据吉福兹法律中心年度枪支法律记分卡，各州被分为五个队列，构建了两组：严格（A、B、C）和宽松（D、F）。我们研究了以下两种情况的影响：（1）一个单一的不匹配邻居，如果该州与≥1 个州的等级评分差异>1，则定义为“不同”，以及（2）所有邻近州的平均等级，如果所有邻近州的平均等级导致等级评分差异>1，则定义为“不同”。
结果
具有相似平均邻居的严格州的 CDR 明显低于具有不同平均邻居的严格州（2.98 [1.91-5.06] 与 3.87 [2.37-5.94]，p=0.02），而具有相似平均邻居的宽松州的 CDR 明显高于具有不同平均邻居的宽松州（6.02 [4.56-8.11] 与 4.7 [3.95-5.35]，p=0.002）。被所有相似宽松州包围的宽松州的 CDR 最高，明显高于至少有一个不同邻居的宽松州（6.52 [5.09-8.96] 与 5.19 [3.85-6.61]，p<0.001）。然而，具有≥1 个不同邻居的严格州的 CDR 并不高于被所有相似严格州包围的严格州（3.39 [2.17-5.35] 与 3.14 [1.91-5.38]，p=0.5）。
结论
我们报告了一种不平衡的相邻效应，即宽松州可能受益于至少一个严格州，而严格州可能仅在被大多数宽松州包围时受到不利影响。这些发现可能有助于政策制定者了解其所在州立法在不匹配的相邻州背景下的效果。
证据水平
预后和流行病学；IV 级。
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