In 1994, there were 39,720 firearm-related deaths in the United States, nearly twice the total number of deaths (19,945) among residents of the state of West Virginia in that same year. In this country firearms, especially handguns, dominate as the weapon of choice in intentional violence, a phenomenon that shows no signs of decreasing in magnitude. The statistics on firearm violence in our nation are staggering, revealing a burden on society heavy in both human and financial terms. In 1985 an estimated $911 million was spent on direct health care expenses alone incurred from firearm-related injuries; over 80% of these costs were paid for with public funds (1). As part of a national strategy to address the issue, the Healthy People 2000 initiatives have targeted overall injury control and prevention, with special attention to the problem of intentional, unintentional, and self-inflicted firearm injury.
Considerable variation in firearm-related mortality exists among the states. The latest year for which state data were available at the time of this study was 1991. The U.S. Centers for Disease Control and Prevention (CDC) recently released a report that included crude rates of total firearm-related mortality (including unintentional, suicide, homicide, and legal intervention deaths) for all 50 states and the District of Columbia in that year (2) (Table 1). The data provide a state-by-state snapshot of firearm-related mortality across the country. The rates ranged from a low of 5.0 (firearm-related deaths per 100,000 population) in Hawai'i to a high of 57.5 in the District of Columbia, with a U.S. average of 15.2. West Virginia's crude rate of firearm-related mortality in 1991 was 16.2.
Lethality and Impulsiveness. Firearms are different from other weapons: they possess a far greater lethality. It is firmly established that assaults, robberies, and suicide attempts are less likely to be fatal if a weapon other than a firearm is used (3). Impulsive behavior (particularly among youth) is an additional factor in assessing the problem of firearm violence; if a firearm were not readily available, the use of another, less lethal, weapon might change the outcome of a violent event, whether interpersonal or self-directed (3). Two recent studies conducted in Massachusetts and Oregon support the evidence that firearms pose a greater risk of serious injury or fatality than other weapons.
In 1989, the Massachusetts Department of Public Health began a pilot project to develop the first statewide emergency-department-based Weapons-Related Injury Surveillance System (WRISS) in the country (4). From November 1993-April 1994, the first six months of reporting, 1,345 weapon-related injuries were reported to WRISS, 451 of which were gunshot wounds (GSWs) and 894 sharp instrument wounds (SIWs). When the severity of the injuries was compared between the two types of wounds, persons with GSWs were more likely to be hospitalized (53%) than persons with SIWs (29%).
The State Health Division of the Oregon Department of Human Resources conducted a study of fatal and nonfatal suicide attempts among adolescents in Oregon from 1988-93 (5). Over the six-year period, there were 3,783 suicide attempts among persons aged 17 and under; 124 attempts resulted in death. The most common method of attempted suicide among this age group was the ingestion of drugs (75.5%), followed by cutting/piercing (11.1%), other poisonings (4.8%), suffocation/hanging (2.4%), and firearms (0.6%). The more common methods used were the least likely to result in death; for example, only 0.4% of all attempts by drug overdose were fatal. In contrast, 78.2% of attempts involving firearms resulted in the death of the adolescent. Sixty-four percent (63.7%) of all suicide deaths among adolescents in Oregon from 1988-93 were the result of firearm use.
At-Risk Populations. Firearm violence strikes harder at certain segments of our society, in particular youth and young adults. Among all persons aged 10-34, firearm injuries were second only to motor vehicle accidents as the leading cause of death in the U.S. in 1990 (1). Among black males aged 15-34, firearm injuries are now the number one cause of death (1). A 1994 CDC study revealed that the rate of homicide among all 15-to-19-year-old males in the nation increased by 154% (from 13.0 to 33.0 deaths per 100,000 15-to-19-year-old males) between 1985 and 1991; firearm-related homicides accounted for 97% of this increase (6).
Older persons (aged 65+) are more at risk from firearm suicide than others, and the percentage of firearm-related suicides among that age group is growing (7). According to a CDC study released in 1996, from 1980 through 1992 firearms were the most common method of suicide used by both men and women aged 65 and older. Over that time period, the percentage of firearm-related suicides among men increased from 69% to 77%; the percentage among women increased from 24% to 35%. The overall rate of firearm-related suicide increased from 10.6 (deaths per 100,000 population aged 65+) to 13.1 deaths.
The poor are also at higher risk of firearm-related mortality, according to Baker et al
in The Injury Fact Book (8). Statistics show that firearm suicide is
twice as common in low income areas. Homicides due to firearms are three times more likely
among low-income populations; unintentional firearm deaths are seven times more common.
Purpose of this Study. West Virginia is a rural state, and firearms have always been part of our culture. Hunting is a prominent activity, both as a sport and a means of supplementing the diet of rural families, and many homes in the state have rifles and shotguns for that purpose. Handguns traditionally have not been a favorite weapon of state gun owners, but the times are changing in West Virginia as well as in the rest of the country, and crime and the fear of crime are increasing. The primary focus of this study entails a detailed examination of the role played by firearms in mortality in West Virginia, with comparisons to the U.S. as a whole to determine if the state is following the nation's trends in firearm violence.
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Health Statistics Center
Office of Epidemiology and Health Promotion
West Virginia Bureau for Public Health
Last updated 02/07/06