After adjusting for income, education, employment rates, and other factors, the most rural counties had over 1.5 times the rate of gun suicides compared to the most urban counties. At the same time, urban areas experienced almost twice the gun homicide rate of the most rural counties. Similar trends were not found for other, non-gun forms of suicide or homicide.
The investigators analyzed urban-rural differences in intentional firearm deaths--homicides and suicides--using over 580,000 death certificates from 1989 to 1999 in all counties in the United States. Their findings are reported in the October issue of the American Journal of Public Health.
Over the last decade, gun suicides have outpaced gun homicides, accounting for over half of all firearm deaths in the United States. Even with that in mind Branas says that "gun suicide has become the forgotten side of all of this, and to reduce gun death in general we have to start making gun suicide a priority."
In the 1990s, a great deal of legislation was aimed at reducing gun homicide, which decreased in the United States by about 5 percent per year. Much of this decrease was in big cities. But almost no attention has been paid to gun suicide, which increased by about 1 to 2 percent per year, most starkly in rural areas, over the same period.
"Ultimately we need to bring gun suicides out of the closet and raise public awareness about these tragic events," says Branas. "We have to think more broadly about preventing gun suicide, especially in rural communities, through such efforts as better detection of mental-health problems and reduced access to guns for people who are known to be at risk for suicide."
Gun death should be broadly thought of as a public health issue, adds Branas, since it includes gun suicide, which often falls outside the bounds of the criminal justice and medical-care systems. "Killing yourself with a gun is not a crime and the results are so immediate that a hospital is very often bypassed for the morgue," he says.
The study also found that the same trend for gun death did not hold true for urban- versus-rural differences in non-gun methods of suicide or homicide. Thus, guns clearly functioned differently from other methods. But why the urban-rural difference? "We didn't directly account for differences in availability of guns by location, but we can speculate how that might have affected our results," says Branas, referring to the larger percentage of gun owners in rural areas versus cities. "A major take-home message from these findings is that although prevention efforts must be continued in big cities, dispelling the urban myth that gun death does not touch areas outside of big cities should be a high priority."
This work was funded by grants from the National Institute on Aging and the Chicago-based Joyce Foundation. Other Penn researchers contributing to the study are Drs. Michael L. Nance, Michael R. Elliott, Therese S. Richmond, and C. William Schwab. This release can also be found at: www.uphs.upenn.edu/news
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Journal
American Journal of Public Health