Homicide Rates Across County, Race, Ethnicity, Age, and Sex in the US: A Global Burden of Disease Study.

IMPORTANCE

Homicide is one of the leading causes of death in the US, especially among adolescents and adults younger than 45 years. While geographic, racial and ethnic, and sex differences in homicide rates have been documented, a comprehensive assessment across all sociodemographics is needed.

OBJECTIVE

To assess variation in US homicide rates from 2000 to 2019 across geographic location, race and ethnicity, sex, and age.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used deidentified death records from the National Vital Statistics System and population estimates from the National Center for Health Statistics for all individuals living in the US from January 1, 2000, to December 31, 2019. Data analysis was completed in April 2023.

EXPOSURE

County, race and ethnicity (American Indian or Alaska Native, Asian or Pacific Islander, Black, Hispanic or Latino, and White), age (0-14, 15-24, 25-44, 45-64, and ≥65 years), and sex (female and male) as reported on death certificates.

MAIN OUTCOMES AND MEASURES

The main outcome was homicide rates per 100 000 individuals. Validated small-area estimation models were used to estimate county-level homicide rates by race and ethnicity, age, and sex (50 unique populations). Estimates were corrected for race and ethnicity misclassification on death certificates and were age standardized.

RESULTS

Between 2000 and 2019, there were 367 827 (95% uncertainty interval [UI], 366 683-369 046) homicides in the US, with decedents most commonly being male (77.7% [95% UI, 77.5%-77.8%]), aged 15 to 44 years (69.8% [95% UI, 69.6%-69.9%]), and Black (46.0% [95% UI, 45.5%-46.5%]). The highest homicide rates were among Black males aged 15 to 24 years (74.6 [95% UI, 72.3-77.0] per 100 000 population) and 25 to 44 years (70.0 [95% UI, 68.4-71.4] per 100 000 population) followed by American Indian and Alaska Native males aged 15 to 24 years (24.5 [95% UI, 19.2-31.0] per 100 000 population) and 25 to 44 years (33.5 [95% UI, 28.6-38.8] per 100 000 population). Homicide rates higher than 100 deaths per 100 000 population among American Indian or Alaska Native or Black males aged 15 to 44 years were observed in 143 counties; more than 25% of counties with this homicide level among Black males were in Arkansas, Louisiana, and Mississippi, and all counties with this homicide level among American Indian or Alaska Native males were in North Carolina. Despite national homicide rates remaining stable over the study period (6.1 [95% UI, 6.0-6.2] per 100 000 population for both years; incidence rate difference, 0.04 [95% UI, -0.16 to 0.07]), homicide rates increased in most counties (range, 1631 of 3051 [53.5%] to 1406 of 1488 [94.5%]) among American Indian or Alaska Native, Black, and White males and females younger than 65 years.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study of US homicide rates, substantial variation was found across and within county, race and ethnicity, sex, and age groups; American Indian and Alaska Native and Black males aged 15 to 44 years had the highest rates of homicide. The findings highlight several populations and places where homicide rates were high, but awareness and violence prevention remains limited.