Lee Esther, Pan Wenchu, Wang Lu, Heinze Justin
Department of Health Behavior and Health Equity, University of Michigan School of Public Health, Ann Arbor, MI, United States; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, United States.
Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, United States.
Soc Sci Med. 2025 Oct;382:118371. doi: 10.1016/j.socscimed.2025.118371. Epub 2025 Jul 3.
Firearm injury is a dire public health crisis in the United States. While its mental health impacts are well-documented, its associations with chronic disease outcomes, particularly at the contextual level, remain underexplored. This gap is especially important given that cardiovascular disease (CVD) is the leading cause of death in both Michigan and the U.S. overall. This study examines the association between census-tract-level firearm incidents and stress-related CVD mortality in Michigan. Using data from the Michigan Incident Crime Reporting System and mortality records from the Michigan Department of Health and Human Services, we analyzed intentional firearm incidents and CVD deaths across six counties from 2017 to 2021. Multilevel logistic regression was used to assess whether census-tract firearm incidents were associated with stress-related CVD mortality, adjusting for individual- and tract-level covariates. Tract-level firearm incidents were significantly associated with higher odds of stress-related CVD mortality. Specifically, each additional 10 firearm incidents per year within a census tract was linked to a 1.6 % increase in the odds of stress-related CVD death. This association remained significant after adjusting for individual factors (age, sex, race/ethnicity, education, tobacco use) and tract-level urbanicity and poverty. Given the high rates of firearm violence in some Michigan counties, residents in high-violence census tracts may face disproportionately greater cumulative risks of stress-related CVD mortality over time. These findings highlight the importance of considering firearm violence as a localized environmental factor of cardiovascular health and the need to account for multi-level factors and approaches to comprehensively understand and improve CVD outcomes.
在美国，枪支伤害是一场严峻的公共卫生危机。虽然其对心理健康的影响已有充分记录，但它与慢性病结局的关联，尤其是在背景层面，仍未得到充分探索。鉴于心血管疾病（CVD）是密歇根州和美国总体上的主要死因，这一差距尤为重要。本研究考察了密歇根州人口普查区层面的枪支事件与应激相关的心血管疾病死亡率之间的关联。利用密歇根州事件犯罪报告系统的数据以及密歇根州卫生与公众服务部的死亡率记录，我们分析了2017年至2021年六个县的故意枪支事件和心血管疾病死亡情况。采用多水平逻辑回归来评估人口普查区的枪支事件是否与应激相关的心血管疾病死亡率相关，并对个体和区域层面的协变量进行了调整。区域层面的枪支事件与应激相关的心血管疾病死亡率较高的几率显著相关。具体而言，人口普查区内每年每增加10起枪支事件，与应激相关的心血管疾病死亡几率就会增加1.6%。在调整了个体因素（年龄、性别、种族/族裔、教育程度、烟草使用）以及区域层面的城市化程度和贫困程度后，这种关联仍然显著。鉴于密歇根州一些县枪支暴力发生率较高，随着时间的推移，高暴力人口普查区的居民可能面临应激相关的心血管疾病死亡累积风险过高的情况。这些发现凸显了将枪支暴力视为心血管健康的局部环境因素的重要性，以及考虑多层次因素和方法以全面理解和改善心血管疾病结局的必要性。
