From the Department of Surgery (A.D.L., E.S.D., X.Z., K.K., C.T., S.E.S., D.R.S.), Boston University Chobanian & Avedisian School of Medicine; Division of Trauma and Acute Care Surgery (C.T., S.E.S., D.R.S.), Boston Medical Center; and Division of Trauma and Acute Care Surgery (T.S.B.), Cedars-Sinai Medical Center, Boston, Massachusetts.
J Trauma Acute Care Surg. 2024 Jul 1;97(1):142-148. doi: 10.1097/TA.0000000000004309. Epub 2024 Mar 18.
Firearm homicides (FH) are a major cause of mortality in the United States. Firearm law implementation is variable across states, and legislative gaps may represent opportunities for FH prevention. For each state, we sought to identify which firearm law category would have been most effective if implemented and how effective it would have been.
We conducted a retrospective cohort study examining the effects of firearm laws on FH rates in the 48 contiguous US states 2010 to 2019. Data were obtained from the CDC WONDER and FBI UCR databases, State Firearm Law Database, and US Census. Firearm laws were grouped into 14 categories. We assessed the association between the presence of each law category and FH rate as an incidence rate ratio (IRR) using a Poisson regression accounting for state population characteristics and laws of surrounding states. We estimated the IRR for each state that did not have a given law category present and determined which of these missing law categories would have been associated with the greatest reduction in FH rate.
FH rates varied widely across states and increased from a mean of 3.2 (SD = 1.7) to 4.2 (SD = 2.9) FH per 100,000. All law categories were significantly associated with decreased FH rate ( p < 0.05), with IRR ranging from 0.25 to 0.85. The most effective missing law category differed between states but was most commonly child access prevention (34.09% of states), assault weapons and large-capacity magazines (15.91%), preemption (15.91%), and concealed carry permitting (13.64%). In total across 2010 to 2019, we estimated that 129,599 fewer FH would have occurred with enactment of the most effective missing law category in each state.
Modeling firearm law prevention of FH with regard to state legislative and population characteristics can identify the highest impact missing law categories in each state. These results can be used to inform efforts to reduce FH.
Prognostic and Epidemiological; Level IV.
在美国，枪支凶杀案（FH）是导致死亡的主要原因之一。枪支法律的实施在各州之间存在差异，立法空白可能是 FH 预防的机会。对于每个州，我们试图确定如果实施了哪个枪支法律类别，其效果将是最有效的，以及其效果将是多么有效。
我们进行了一项回顾性队列研究，调查了 2010 年至 2019 年期间枪支法律对美国 48 个州 FH 发生率的影响。数据来自疾病控制与预防中心（CDC）的 WONDER 和联邦调查局（FBI）的 UCR 数据库、州枪支法律数据库和美国人口普查。将枪支法律分为 14 类。我们使用泊松回归，根据州人口特征和周边州的法律，评估每个法律类别存在与否与 FH 率之间的关联，以发病率比（IRR）表示。我们估计了每个没有特定法律类别的州的 IRR，并确定了这些缺失的法律类别中哪些与 FH 率的最大降低相关。
FH 率在各州之间差异很大，从平均每 100,000 人 3.2（SD=1.7）增加到 4.2（SD=2.9）。所有法律类别均与 FH 率降低显著相关（p<0.05），IRR 范围为 0.25 至 0.85。最有效的缺失法律类别因州而异，但最常见的是儿童接触预防（34.09%的州）、攻击性武器和大容量弹夹（15.91%）、先发制人（15.91%）和隐蔽携带许可（13.64%）。在 2010 年至 2019 年期间，我们估计，如果在每个州颁布最有效的缺失法律类别，将有 129,599 例 FH 得以避免。
根据州立法和人口特征对 FH 的枪支法律预防进行建模，可以确定每个州最具影响力的缺失法律类别。这些结果可用于减少 FH 的努力。
预后和流行病学；四级。
