Gun deaths and injuries in California spike following Nevada gun shows

1. Data shows that gun deaths, injuries in California spike following Nevada gun shows

Findings suggest that lack of federal gun legislation reduces the impact of state laws intended to protect citizens from firearm injury and death

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State laws seem to matter when it comes to preventing firearm injuries and death. A study from the University of California Berkley found that when gun shows were held in Nevada, a state with some of the least restrictive gun laws in the country, gun-related deaths and injuries in neighboring California spiked by nearly 70 percent for at least the next two weeks. When gun shows were held in California, a state with some of the most restrictive gun-control laws, there was no spike in gun deaths or injuries in the state. The findings are published in Annals of Internal Medicine.

More than 4,000 gun shows are held annually in the U.S., and gun shows account for 4 to 9 percent of annual firearm sales. Some gun shows draw thousands of attendees and hundreds of sellers, whose transactions may be subject to less oversight. In many states, these transactions do not involve a background check, and research has shown that firearms from gun shows are disproportionately implicated in crimes.

Using data on 915 gun shows, researchers compared firearm injury rates for the 2 weeks immediately before and after gun shows held in Nevada (mostly in Reno and Las Vegas) and gun shows held in California between 2005 and 2013. They found that compared to the two weeks before the gun shows occurred, post-show firearm injury rates remained stable in regions near California gun shows. But post-show firearm injury rates increased from 0.67 to 1.14 per 100,000 people in regions near Nevada shows. This 70 percent increase translates to 30 more firearms deaths or injuries in the sparsely populated California border region after 161 Nevada gun shows.

According to the authors of an accompanying editorial from the University of Washington, these findings suggest that travel to less restrictive states may threaten the effectiveness of firearm laws within California.

The study was funded in part by the National Institutes of Health (NIH), through a NIH Director's New Innovator Award to Jennifer Ahern, Associate Professor in the School of Public Health at Berkeley, and the study's senior author. Additional funding was provided by Heising-Simons Foundation.

Media contacts: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, Ellicott Matthay, MPH, please contact Brett Israel at brett.israel@berkeley.edu or 510-643-7741.

2. Survey: Vast majority of Americans do not believe that owning a firearm increases suicide risk

Abstract: http://annals.org/aim/article/doi/10.7326/M17-2348

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A nationally representative survey of nearly 4,000 people found that the vast majority of Americans do not believe that owning a firearm increases the risk for suicide. The findings of a brief research report are published in Annals of Internal Medicine.

In 2015, more than 44,000 people committed suicide and half of them used a firearm. Addressing beliefs about the relationship between firearms and suicide in the United States is likely to improve prevention strategies that aim to lower suicide rates through reducing access to firearms. Therefore, it is important to understand public opinion about this issue.

Researchers from Northeastern University and the Harvard School of Public Health used data from a 2015 Web-based survey conducted by Growth for Knowledge. The researchers analyzed respondents' answers to the statement, "Having a gun in the home increases the risk for suicide." Respondents options were "strongly agree," "agree," "neither," "disagree," and "strongly disagree." Of the 3,949 persons who completed the survey, a total of 15.4 percent agreed with the survey statement. The proportion of respondents who agreed with the statement was much higher among health care providers, with 1 in 3 agreeing that having a household firearm increases suicide risk. Fewer than 10 percent of gun owners with children agreed with the statement.

According to the researchers, these findings may reflect broad skepticism about the effectiveness of preventing suicide by reducing access to means of suicide with high case fatality rates. The researchers conclude that medical and public health communities need to better educate at-risk patients and health care providers about how and why firearms increase the risk for suicide.

Media contacts: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, Andrew Conner, BS, please contact Matthew Miller, MD, MPH, ScD at ma.miller@neu.edu.

3. Only a small fraction of diabetes cases go undiagnosed

These findings challenge previously published estimates and suggest that diabetes screening and diagnosis efforts are working

Abstract: http://annals.org/aim/article/doi/10.7326/M17-1272
Editorial: http://annals.org/aim/article/doi/10.7326/M17-2576

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When a confirmatory definition is used, undiagnosed diabetes is a relatively small fraction of the total diabetes population. These findings challenge previously published national estimates, which suggest that one quarter to one third of diabetes cases are undiagnosed, and suggest that diabetes screening and diagnosis efforts are more effective than might be inferred from the literature. The results of a cross-sectional study are published in Annals of Internal Medicine.

Currently accepted estimates suggest that approximately 25 to 30 percent of diabetes cases go undiagnosed. This conclusion is based on epidemiologic surveys of respondents who had a single test of fasting glucose, HbA1C, or 2-hour glucose level to diagnose their diabetes. However, the American Diabetes Association recommends repeating a positive test to confirm the diagnosis. Utilizing this approach decreases false-positives and may provide a more accurate picture of undiagnosed diabetes in the United States.

Researchers from Johns Hopkins Bloomberg School of Public Health challenged the single test estimates by reanalyzing results of the NHANES (National Health and Nutrition Examination Survey) from 1988 to 1994 and 1999 to 2014. Confirmed undiagnosed diabetes was defined as elevated levels of both fasting glucose and HbA1C in persons without diagnosed diabetes. When using the confirmatory approach, the prevalence of total diabetes increased from 5.5 percent in 1988 to 1994 to 10.8 percent in 2011 to 2014. During this period, the number of cases of confirmed undiagnosed diabetes increased from 0.89 percent to 1.2 percent; however, confirmed undiagnosed diabetes as a proportion of total diabetes cases decreased from 16.3 percent to 10.9 percent.

In a related commentary, Ann Peters, MD, of the Keck School of Medicine, University of Southern California, Los Angeles, writes that these findings are encouraging because they show that health care providers are not missing as many diabetes cases as previously thought and that the proportion of cases is decreasing. However, patients with undiagnosed diabetes are still being missed, particularly those who may not have regular access to health care or who have several risk factors. Targeted public health efforts may help these patients get the screening they need.

Media contacts: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, Elizabeth Selvin, PhD, MPH, please contact Barbara Benham at bbenham1@jhu.edu. To interview Dr. Peters, please contact Cynthia Smith at Cynthia.Smith@med.usc.edu.

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Also in this issue:

Synopsis of the 2017 U.S. Department of Veterans Affairs/U.S. Department of Defense Clinical Practice Guideline: Management of Type 2 Diabetes Mellitus
Paul R. Conlin, MD; Jeffrey Colburn, MD; David Aron, MD, MS; Rose Mary Pries, DrPH; Mark P. Tschanz, DO, MACM; Leonard Pogach, MD, MBA
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Abstract: http://annals.org/aim/article/doi/10.7326/M17-1362

When Clinical Practice Guidelines Collide: Finding a Way Forward
Sheldon Greenfield, MD; Sherrie H. Kaplan, PhD, MPH
Editorial
Abstract: http://annals.org/aim/article/doi/10.7326/M17-2665

Introducing a Patient Portal and Electronic Tablets to Inpatient Care
Timothy R. Huerta, PhD, MS; Ann Scheck McAlearney, ScD, MS; and Milisa K. Rizer, MD, MPH
Ideas and Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M17-1766

Technology and Medicine: Reimagining Provider Visits as the New Tertiary Care
Christian Terwiesch, PhD; David A. Asch, MD, MBA; and Kevin G. Volpp, MD, PhD
Ideas and Opinions
Abstract: http://annals.org/aim/article/doi/10.7326/M17-0597