Hemenway David, Azrael Deborah, Zhang Wilson, Miller Matthew
Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA.
Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA.
J Natl Med Assoc. 2023 Apr 15. doi: 10.1016/j.jnma.2023.03.008.
Ecologic studies have examined the relationship across states between levels of household gun ownership and suicide rates using household gun ownership data from the Behavioral Risk Factor Surveillance System (BFRSS) or proxies. However, no study has examined how race-specific survey-based or proxy measures of gun ownership are related to race-specific suicide rates.
We use cross-sectional state-level race-specific data to examine how well various proxies correlate with race-specific BRFSS gun ownership rates. We examine whether BRFSS measures of household gun ownership are correlated with firearm suicide, non-firearm suicide, and total suicide rates, for Black and for White adults, and repeat these assessments with select proxies. The core BRFSS only included gun questions in 2001, 2002, and 2004, but not since; mortality data are collapsed 2001-2010.
Among a set of proxies, the race-specific fraction of suicides that are firearm suicides (FS/S) is the measure most highly correlated with BRFSS household gun ownership. Across states, White adult BFRSS household gun ownership levels are highly correlated with White adult firearm suicide rates (correlation coefficient .82) and moderately correlated with White overall suicide rates (.63). However, for Black adults, we find that while the state-level Black gun ownership levels are moderately correlated with Black firearm suicide rates (.67)-more strongly for older (.70) than for younger (.47) Black adults-Black BRFSS gun ownership levels are only weakly correlated with Black overall suicide rates (.17) owing to a moderate inverse correlation with Black non-firearm suicide rates (-.45). For Black adults, the relationship between FS/S and suicide is similar to the relation between BRFSS and suicide.
For White adults, states with higher levels of measured household gun ownership have higher overall suicide rates. This relationship does not hold for Black adults, largely due to a more attenuated correlation between these measures of firearm availability and firearm suicide rates coupled with a more substantial countervailing (inverse) relationship between these measures and non-firearm suicide rates. Future efforts using individual level data might help determine why this puzzling difference exists, especially for young Black adults.
生态学研究利用行为风险因素监测系统(BFRSS)的家庭枪支拥有数据或替代指标,考察了各州家庭枪支拥有水平与自杀率之间的关系。然而,尚无研究考察基于调查的特定种族枪支拥有量测量指标或替代指标与特定种族自杀率之间的关系。
我们使用州层面的横断面特定种族数据,来考察各种替代指标与特定种族的BFRSS枪支拥有率之间的关联程度。我们考察BFRSS的家庭枪支拥有量测量指标是否与黑人及白人成年人的枪支自杀率、非枪支自杀率和总自杀率相关,并使用选定的替代指标重复这些评估。BFRSS核心问卷仅在2001年、2002年和2004年包含枪支相关问题,此后不再包含;死亡率数据涵盖2001 - 2010年。
在一组替代指标中,特定种族的枪支自杀占自杀总数的比例(FS/S)是与BFRSS家庭枪支拥有量相关性最高的指标。在各州中,白人成年人的BFRSS家庭枪支拥有水平与白人成年人枪支自杀率高度相关(相关系数为0.82),与白人总体自杀率中度相关(0.63)。然而,对于黑人成年人,我们发现虽然州层面的黑人枪支拥有水平与黑人枪支自杀率中度相关(0.67)——年龄较大的黑人成年人(0.70)比年龄较小的黑人成年人(0.47)相关性更强——但黑人的BFRSS枪支拥有水平与黑人总体自杀率仅呈弱相关(0.17),这是因为与黑人非枪支自杀率呈中度负相关(-0.45)。对于黑人成年人,FS/S与自杀之间的关系类似于BFRSS与自杀之间的关系。
对于白人成年人,家庭枪支拥有量测量水平较高的州总体自杀率也较高。这种关系在黑人成年人中不成立,主要是因为这些枪支可得性指标与枪支自杀率之间的相关性较弱,同时这些指标与非枪支自杀率之间存在更显著的抵消(负)关系。未来使用个体层面数据的研究可能有助于确定为何存在这种令人困惑的差异,尤其是对于年轻黑人成年人。