by Kevin Schofield

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Content Note: This article discusses both homicide and suicide by firearm.

This weekend’s read is a newly published deep dive into the statistics on firearm-related fatalities in the United States, by a group of pediatric medical researchers led by Emory University. The researchers used data on firearm death incidents collected by the Centers for Disease Control and Prevention (CDC) from 1990 to 2021, to look at “trends and disparities.” What makes their report interesting is how they chose to visualize the data — and what that visualization brings to the forefront.

We can assume the CDC data set probably had at least 15 to 20 different dimensions to it, each representing a way to subset the data into smaller demographic groups, such as by age, race and ethnicity, or geography. The researchers chose to focus on eight dimensions they found to be interesting — though, again, we can assume they looked at the others and found them not worth reporting on. Still, an eight-dimensional data set is difficult to visualize; most data charts are two-dimensional. The researchers decided to use “heat maps,” which are basically two-dimensional charts that use a spectrum of colors to sneak in a third dimension. They then generated a lot of heat maps, rotating through the other dimensions looking for patterns, trends, and “hot spots.” And they found several.

One of the most important insights about U.S. firearm fatalities — and one that most people aren’t aware of — is that the majority are suicides, not homicides. According to the CDC, between 1990 and 2021, there were 1,110,421 firearm deaths, of which 56% were suicides and 39% were homicides. Both are incredibly high numbers, and each is a tragic public health crisis, but as we will see, the stories for each of them diverge in important ways. If all we look at are the top-level numbers, then we completely miss what is going on with firearms in our country.

The heat maps show us that firearm homicide rates are highest among Black and Hispanic men. Among younger Black men, this has been constant for the past 30 years; for older Black men, it trended down through the 2000s and 2010s, but since the start of the COVID-19 pandemic in 2020, it has begun to rise again. For Hispanic men, there was a substantial improvement over the past 20 years, but again over the past two years, things have gone in the wrong direction. White and Hispanic women are rarely firearm homicide victims; and again, for most of the past 20 years, the rate has improved substantially for Black women but is trending back up now. 

Finally, the heat maps show that firearm homicides are more prevalent in metropolitan areas than in non-metropolitan ones — though both have trended up in the past two years. 

The heat maps for firearm suicides are similar in one respect: They are very low for female victims. But in almost all other ways, they tell a completely different story. A full 86% of firearm suicide victims are male; 85% are white; 73% are white men. Among both Black and Hispanic men, firearm suicides have been trending down for 30 years; though, once again, since 2020, there seems to be a worrisome uptick. Age is also a major factor: The researchers found that white men over the age of 70 had the highest rate of firearm suicides. Firearm suicide rates among women of all races and ethnicities are low; the researchers note that this is consistent with other research showing that women tend to commit suicide by poison rather than firearms. That is a critical piece of context: We need to continue to worry about and provide help for women who are at risk of attempting suicide, understanding that they will likely choose a method other than a gun.

The heat maps also show us that firearm suicides are far more prevalent in non-metropolitan areas, which is again the reverse of what we saw for homicides. 

The researchers provided a separate set of heat maps to explore the relationship to geographic location, and, again, the disparity between homicides and suicides is clear. Firearm suicides have spiked in the mountainous and rural West, whereas homicides have been concentrated in the Deep South. Tragically, there is one state that is now seeing elevated numbers of both homicides and suicides: Alaska.

The researchers have shown us, in extremely clear terms, that our country is facing two separate public health crises related to firearms. The first is the crisis of homicides, which has its highest rate among young Black and Hispanic men and is concentrated in metropolitan areas and in the Deep South. The second and larger one is the crisis of suicides, of which the vast majority are older white men, and it is primarily in non-metropolitan and rural areas in the western part of the country.

There is a lot this research report doesn’t tell us. For starters, it says nothing about who is pulling the trigger in the homicides, or the circumstances surrounding them. Finding interventions and solutions will require knowing more about whether they were connected to crimes of poverty, drugs, domestic violence, or other causes. There are, of course, many organizations on the ground in local communities, including ours, that are working to prevent firearm deaths, but if we want state and federal governments to support and supplement local efforts at a larger scale, then we need better information about where resources can do the most good. 

We also need to learn more about what is leading people to commit suicide by firearm — and especially older men, for whom the crisis is most severe. Finally, we need to come to grips with the rise in both homicides and suicides over the past two years, what it means for our society, and what interventions may reverse it. Obviously, limiting access to firearms is part of the equation, but only part of it; that must be paired with an understanding of the path that leads someone to the moment where they pull a trigger.

Trends and Disparities in Firearm Fatalities in the United States, 1990-2021

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📸 Featured Image: “Figure 5. Geographic Distribution of Firearm Fatalities at County Level” via Rees CA, Monuteaux MC, Steidley I, et al. Trends and Disparities in Firearm Fatalities in the United States, 1990-2021. JAMA Netw Open. 2022;5(11):e2244221. doi:10.1001/jamanetworkopen.2022.44221; used under a Creative Commons CC-BY-SA license.

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