PPubMed17 Dec 2019Cited 154×

Social determinants of health in relation to firearm-related homicides in the United States: A nationwide multilevel cross-sectional study Social determinants of health in relation to firearm-related homicides in the United States

Daniel Kim, Karim Brohi

Abstract

The US is grappling with a worsening epidemic of gun homicides. Between 2001 and 2013, guns took the lives of more Americans than the total number killed by war, AIDS, illegal drug overdoses, and terrorism combined during the same period . Gun homicides rose consecutively in 2015, 2016, and 2017 , and are the second leading cause of injury death among youths and young adults . Identifying the key drivers of firearm violence is crucial to its prevention. While a growing literature has explored the impacts of state gun control policies , there are increasing calls for comprehensive, multidiscipl

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US census‑tract study links higher income inequality and lower social capital, welfare spending, and mobility to more firearm homicides.

What’s new

i.Nationwide multilevel analysis of 74,134 census tracts covering all contiguous US
ii.First comprehensive lagged investigation of multiple social determinants on firearm homicide and mass shooting rates
iii.Identification of specific associations: income inequality ↑10% homicide risk, welfare spending ↓17‑19%, institutional social capital ↓16‑17%, social mobility ↓24%
iv.Use of 5‑year and 17‑year lag periods to capture delayed effects of spending and inequality
v.Provision of extensive supplementary tables and causal mediation analyses

How they did it

The authors performed a cross‑sectional multilevel study using publicly available census, election, and survey data for all 74,134 census tracts. They applied generalized estimating equations (GEE) in SAS 9.4 with lagged exposure variables (5‑year lag for social spending, 17‑year lag for income inequality) to model incident counts of firearm homicides.

What they found

1‑SD increase in county Gini coefficient → 10% higher total firearm homicide incidents (IRR=1.10, 95% CI 1.03‑1.17, p=0.003)
Higher welfare spending → 17‑19% lower incident count (IRR≈0.83, 95% CI 0.79‑0.87, p<0.001)
1‑SD increase in institutional social capital → 16‑17% lower homicide count (IRR=0.83, 95% CI 0.73‑0.95, p=0.01)
Higher social mobility → 24% lower non‑mass shooting homicide count (IRR=0.76, 95% CI 0.67‑0.87, p<0.001)
For mass homicides, institutional social capital ↑ associated with 29% lower incident count (IRR=0.71, 95% CI 0.52‑0.98, p=0.04)

Caveats

✕Optimal lag periods for social spending and inequality remain uncertain
✕Models with 3‑year lags failed to converge, limiting sensitivity analyses
✕Effect estimates for mass homicide had wide confidence intervals and non‑significant p‑values (>0.10)
✕Cross‑sectional ecological design limits causal inference

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Social determinants of health in relation to firearm-related homicides in the United States: A nationwide multilevel cross-sectional study Social determinants of health in relation to firearm-related homicides in the United States

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