Trauma in Transition: Trends in Deaths from Firearm and Motor Vehicle Injuries
A report from the Violence Prevention Research Program, University of California, Davis
The Violence Prevention Research Program is located at the University of California, Davis. Its work addresses the causes, nature, and prevention of violence. This project was supported in part by a grant from the California Wellness Foundation.
Suggested citation: Wintemute GJ. Trauma in Transition: Trends in Deaths from Firearm and Motor Vehicle Injuries. Sacramento, CA: Violence Prevention Research Program, 1995.
©1995 by Garen Wintemute
The Violence Prevention Research Program reported in 1993 that if then-current trends continued, firearms would surpass motor vehicles as the nation's leading cause of traumatic death by the year 2004, and possibly as early as 1994 (1). This finding was subsequently confirmed by the Centers for Disease Control and Prevention(2). New data from the National Center for Health
Statistics (3,4) make it possible to update these predictions.
The National Center for Health Statistics has issued a provisional estimate that in 1993 there were 40,230 deaths due to firearm injuries and 40,880 deaths from motor vehicle injuries. This difference of 650 deaths is within the range of error of the estimates. (The 95 percent confidence interval for the estimated number of firearm-related deaths was 39,040 to 41,420 deaths; the confidence interval for motor vehicle-related deaths was not reported but would be approximately 39,680 to 42,080 deaths.) The estimated 1993 crude and age-adjusted death rates from firearm injuries were 15.6 per 100,000 persons and 15.7 per 100,000 persons, respectively. By comparison, the estimated crude and age-adjusted death rates from motor vehicle injuries were 15.9 per 100,000 persons and 15.5 per 100,000 persons, respectively.
A comparison of long-term trends in deaths from motor vehicle and firearm injuries is shown in Figure 1. The age-adjusted death rate from motor vehicle injuries peaked in 1969 and had declined by nearly half (46 percent) by 1993. The death rate from firearm injuries reached its modern high point in 1974; after a generally downward trend through 1985 it had increased by 24 percent as of 1993 and was at its highest level since 1932 (5).
The increase in the death rate from firearm injuries has resulted largely from an increase in firearm homicides, which increased by 41 percent over the 10-year period 1984 to 1993 (Table 1). In 1984, firearm suicides outnumbered firearm homicides by more than 40 percent, a pattern which characterized much of the 20th century. By 1993 that margin had been reduced to 6 percent.
Table 1: Death rates from firearm injuries in the United States,
by type of firearm death, 1984 and 1993, with net change over that time period.
|Type of firearm death||Deaths per 100,000 persons per year|
Over the 10-year period 1984 to 1993, trends in death rates from firearm injuries varied substantially by age (Table 2). For persons 35 to 64 years of age, death rates actually declined. The largest increase was seen among teenagers and young adults ages 15 to 24, for whom the death rate from firearm injuries rose 80 percent from 1984 to 1993.
Table 2: Age-specific death rates from firearm injuries in the United States,
1984 and 1993, with net change over that time period.
|Age Group||Deaths per 100,000 persons per year|
The experience of persons 15 to 24 years of age is displayed in more detail in Figure 2. The overall increase in firearm-related deaths in this group occurred largely because the death rate for black males increased more than three-fold, from 55.9 per 100,000 persons in 1984 to 176.8 per 100,000 persons in 1993. This 1993 rate is 5.4 times higher than that for white males ages 15 to 24, and more than 11 times higher than the overall rate for the population of the United States. It is important to recognize that this is an average annual rate for a 10-year period of time. The cumulative incidence of firearm death over this period for black males ages 15 to 24 is approximately 1,770 per 100,000 persons, or 1 in 56.
In 1993, firearm injuries ranked as the nation's eighth leading cause of death and accounted for approximately 27 percent of all injury deaths. For persons ages 15 to 24, firearms accounted for a substantial portion of all deaths in 1993 (Figure 3). For black males in this age group, 63 percent — nearly two thirds — of all deaths were from firearm injuries.
If there is no change in the trends established over the 10 years ending 1993, the death rate from firearm injuries will reach an all-time high in 1994 or 1995. Homicides will substantially outnumber suicides. By the year 2000, firearms will have far outdistanced motor vehicles as the nation's leading cause of traumatic death (Figure 4). From 1993 through the end of the year 2000, an estimated 350,000 people will be shot and killed in the United States. Nearly one third of these will be teenagers and young adults ages 15 to 24 (Figure 5).
There are an estimated 7.5 nonfatal firearm injuries for each fatality (6). By this estimate, the years 1993 to 2000 will also see 2,625,000 nonfatal firearm injuries.
Not quite 30 years ago, the United States made prevention of deaths from motor vehicle injuries a national priority. A systematic study of the problem was followed by concerted action on many fronts. As a result, the death rate from motor vehicle injuries has been cut nearly in half, and an estimated 250,000 deaths have been prevented (2). Death rates from firearm injuries are unlikely to be brought under control until a similar national effort is brought to bear.
- Wintemute GJ. Motor vehicles and firearms; which takes a heavier toll? Journal of the American Medical Association 1993; 269:2213.
- Deaths resulting from firearm- and motor-vehicle-related injuries — United States, 1968-1991. Morbidity and Mortality Weekly Report 1994 Jan 28; 43(3):37-42.
- Annual summary of births, marriages, divorces, and deaths: United States, 1993. Monthly Vital Statistics Report 1994 Oct 11; 42(13). Hyattsville, MD: US Public Health Service. DHHS Publication No. (PHS) 95-1120-4-1958.
- Kochanek KD, Hudson BL. Advance report of final mortality statistics, 1992. Monthly Vital Statistics Report1994 Dec 8; 43 (6 suppl). Hyattsville, MD: US Public Health Service. DHHS Publication No. (PHS) 95-1120-4-2415.
- Wintemute GJ. Firearms as a cause of death in the United States, 1920-1982. Journal of Trauma 1987;27:532-536.
- Max W, Rice DP. Shooting in the dark: estimating the cost of firearm injuries. Health Affairs 1993;12:171-185.
Crude rates were calculated by dividing the number of deaths from a specific cause in a specific year (for the population as a whole, or for specific race and sex groups) by the number of persons in that population in that year. Age-adjusted rates were calculated by the direct method, following procedures used by the National Center for Health Statistics. Age-specific rates for each year are applied to a standard population, the population of the United States as enumerated in 1940. The rate is then the number of deaths that would have been observed if the 1940 population had been subject to the age-specific rates seen in the year in question, divided by the number of persons in the 1940 population. Age-adjusted rates take account of changes in the age composition of the population of the United States over time. They are therefore better suited than crude rates for studies of death over long periods of time. Projections of future death rates were made using linear regression on data for 1984 to1993. Linear extrapolation was used to estimate age-specific firearm death rates for 1990 and 1991.
The National Center for Health Statistics includes all types of firearm death in its rate estimates, listed here with their numeric classification in the External Cause of Death listing in the International Classification of Diseases, 9th Edition: homicide and legal intervention (E 965.0-E965.4, E 970), suicide (E955.0-E955.4), accident (E922), intent undetermined (E985.0-E985.4). That convention has been followed here. There is room for disagreement as to whether it is appropriate to include deaths by legal intervention, such as justifiable homicide, in such mortality studies. These deaths account for approximately 1 percent of all firearm deaths; their inclusion does not materially affect the results presented here.