Homicide and suicide risks associated with firearms in the home: A national case-control study☆☆☆★
Received 25 August 2002; received in revised form 27 November 2002 and 8 January 2003; accepted 12 January 2003.
Abstract
Study objective: I test the hypothesis that having a gun in the home is a risk factor for adults to be killed (homicide) or to commit suicide. Methods: Two case-control analyses were based on national samples of subjects 18 years of age or older. Homicide and suicide case subjects were drawn from the 1993 National Mortality Followback Survey. Living control subjects were drawn from the 1994 National Health Interview Survey. Ten control subjects matched by sex, race, and age group were sought for each case subject. Results: The homicide sample consisted of 1,720 case subjects and 8,084 control subjects. Compared with adults in homes with no guns, the adjusted odds ratio (OR) for homicide was 1.41 (95% confidence interval [CI] 1.20 to 1.65) for adults with a gun at home and was particularly high among women (adjusted OR 2.72; 95% CI 1.89 to 3.90) compared with men (adjusted OR 1.23; 95% CI 1.01 to 1.49) and among nonwhite subjects (adjusted OR 1.74; 95% CI 1.37 to 2.21) compared with white subjects (adjusted OR 1.27; 95% CI 1.03 to 1.56). Further analyses revealed that a gun in the home was a risk factor for homicide by firearm means (adjusted OR 1.72; 95% CI 1.40 to 2.12) but not by nonfirearm means (OR 0.83; 95% CI 0.62 to 1.11). The suicide sample consisted of 1,959 case subjects and 13,535 control subjects. The adjusted OR for suicide was 3.44 (95% CI 3.06 to 3.86) for persons with a gun at home. However, further analysis revealed that having a firearm in the home was a risk factor for suicide by firearm (adjusted OR 16.89; 95% CI 13.26 to 21.52) but was inversely associated with suicide by other means (adjusted OR 0.68; 95% CI 0.55 to 0.84). Conclusion: Having a gun at home is a risk factor for adults to be shot fatally (gun homicide) or commit suicide with a firearm. Physicians should continue to discuss with patients the implications of keeping guns at home. Additional studies are warranted to address study limitations and to better understand the implications of firearm ownership. [Ann Emerg Med. 2003;41:771-782.]
Violence Prevention Research Group, University of California-Los Angeles School of Public Health, Los Angeles, CA.
☆ Dr. Wiebe is currently affiliated with the Department of Biostatistics and Epidemiology, Firearm Injury Center at Penn (FICAP), and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
☆☆ This work was supported at the University of California-Los Angeles in part by a grant from The California Wellness Foundation (TCWF). Partial funding was provided also by Public Health Foundation Enterprises, Inc., through a grant from The California Endowment. The original dissertation research was funded in part by a grant from the School of Social Ecology at the University of California-Irvine.
★ Address for reprints: Douglas J. Wiebe, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania, 933 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021; 215-746-0149, fax 215-573-2265; E-mail dwiebe@cceb.med.upenn.edu.
ABSTRACT