Journal of General Internal Medicine

, Volume 29, Issue 7, pp 1065–1069 | Cite as

Does the Declining Lethality of Gunshot Injuries Mask a Rising Epidemic of Gun Violence in the United States?

Perspective

ABSTRACT

Recent mass shootings in the U.S. have reignited the important public health debate concerning measures to decrease the epidemic of gun violence. Editorialists and gun lobbyists have criticized the recent focus on gun violence, arguing that gun-related homicide rates have been stable in the last decade. While true, data from the U.S. Centers for Disease Control and Prevention also demonstrate that although gun-related homicide rates were stable between 2002 and 2011, rates of violent gunshot injuries increased. These seemingly paradoxical trends may reflect the declining lethality of gunshot injuries brought about by surgical advances in the care of the patient with penetrating trauma. Focusing on gun-related homicide rates as a summary statistic of gun violence, rather than total violent gunshot injuries, can therefore misrepresent the rising epidemic of gun violence in the U.S.

Notes

Acknowledgements

Dr. Jena had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Support was provided by the Office of the Director, National Institutes of Health (1DP5OD017897-01, Dr. Jena).

Conflict of Interest

The authors declare that they do not have a conflict of interest.

REFERENCES

  1. 1.
    Kellermann AL, Rivara FP. Silencing the science on gun research. JAMA. 2013;309:549–50.PubMedCrossRefGoogle Scholar
  2. 2.
    UNODC Homicide Statistics. 2013. (Accessed November 6, 2013, at www.unodc.org).
  3. 3.
    Wintemute GJ. Tragedy’s legacy. N Engl J Med. 2013;368:397–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Years of potential life lost from unintentional injuries among persons aged 0–19 years - United States, 2000–2009. MMWR Morb Mortal Wkly Rep 2012;61:830–3.Google Scholar
  5. 5.
    Eastridge BJ, Jenkins D, Flaherty S, Schiller H, Holcomb JB. Trauma system development in a theater of war: Experiences from Operation Iraqi Freedom and Operation Enduring Freedom. J Traumatol. 2006;61:1366–72. discussion 72–3.Google Scholar
  6. 6.
    Nguyen T, Kalish J, Woodson J. Management of civilian and military vascular trauma: lessons learned. Semin Vasc Surg. 2010;23:235–42.PubMedCrossRefGoogle Scholar
  7. 7.
    Thorson CM, Dubose JJ, Rhee P, et al. Military trauma training at civilian centers: a decade of advancements. J Traumatol Acute Care Surg. 2012;73:S483–9.CrossRefGoogle Scholar
  8. 8.
    DuBose JJ, Barmparas G, Inaba K, et al. Isolated severe traumatic brain injuries sustained during combat operations: demographics, mortality outcomes, and lessons to be learned from contrasts to civilian counterparts. J Traumatol. 2011;70:11–6. discussion 6–8.Google Scholar
  9. 9.
    Holcomb JB, Jenkins D, Rhee P, et al. Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Traumatol. 2007;62:307–10.Google Scholar
  10. 10.
    Perkins JG, Schreiber MA, Wade CE, Holcomb JB. Early versus late recombinant factor VIIa in combat trauma patients requiring massive transfusion. J Traumatol. 2007;62:1095–9. discussion 9–101.Google Scholar
  11. 11.
    Tracy EJ. Combining Military and Civilian Trauma Systems: The Best of Both Worlds. Adv Emerg Nurs J. 2005;27:170–5.Google Scholar
  12. 12.
    Hoff WS, Schwab CW. Trauma system development in North America. Clinical orthopaedics and related research 2004;422:17–22.Google Scholar
  13. 13.
    Harris AR, Thomas SH, Fisher GA, Hirsch DJ. Murder and Medicine: The Lethality of Criminal Assault 1960–1999. Homicide Stud. 2002;6:128–66.CrossRefGoogle Scholar
  14. 14.
    Cook PJ, Lawrence BA, Ludwig J, Miller TR. The medical costs of gunshot injuries in the United States. JAMA. 1999;282:447–54.PubMedCrossRefGoogle Scholar
  15. 15.
    Pennsylvania Health Care Cost Containment Council. Firearm-related injuries in Pennsylvania; 2005.Google Scholar
  16. 16.
    Cook PJ, Ludwig J. Gun Violence: The Real Costs. New York: Oxford University Press; 2000.Google Scholar
  17. 17.
    Hemenway D, Miller M. Firearm availability and homicide rates across 26 high-income countries. J Traumatol. 2000;49:985–8.Google Scholar
  18. 18.
    Miller M, Hemenway D, Azrael D. State-level homicide victimization rates in the US in relation to survey measures of household firearm ownership, 2001–2003. Soc Sci Med. 2007;64:656–64.PubMedCrossRefGoogle Scholar
  19. 19.
    Fleegler EW, Lee LK, Monuteaux MC, Hemenway D, Mannix R. Firearm legislation and firearm-related fatalities in the United States. JAMA Int Med. 2013;173:732–40.CrossRefGoogle Scholar
  20. 20.
    Chapman S, Alpers P, Agho K, Jones M. Australia’s 1996 gun law reforms: faster falls in firearm deaths, firearm suicides, and a decade without mass shootings. Inj Prev. 2006;12:365–72.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Hemenway D. How to find nothing. J Public Health Policy. 2009;30:260–8.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2014

Authors and Affiliations

  1. 1.Department of Health Care PolicyHarvard Medical SchoolBostonUSA
  2. 2.Department of MedicineMassachusetts General HospitalCambridgeUSA
  3. 3.National Bureau of Economic ResearchCambridgeUSA
  4. 4.Department of AnesthesiaStanford University HospitalsStanfordUSA
  5. 5.Medical Oncology BranchNational Cancer Institute, National Institutes of Health, Bethesda, MarylandBethesdaUSA

Personalised recommendations