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Homicide, Suicide, and Unintentional Firearm Fatality: Comparing the United States With Other High-Income Countries, 2003

Richardson, Erin G. S.M.; Hemenway, David PhD

The Journal of Trauma: Injury, Infection, and Critical Care: January 2011 - Volume 70 - Issue 1 - p 238-243
doi: 10.1097/TA.0b013e3181dbaddf
Original Article

Background: Violent death is a major public health problem in the United States and throughout the world.

Methods: A cross-sectional analysis of the World Health Organization Mortality Database analyzes homicides and suicides (both disaggregated as firearm related and non-firearm related) and unintentional and undetermined firearm deaths from 23 populous high-income Organization for Economic Co-Operation and Development countries that provided data to the World Health Organization for 2003.

Results: The US homicide rates were 6.9 times higher than rates in the other high-income countries, driven by firearm homicide rates that were 19.5 times higher. For 15-year olds to 24-year olds, firearm homicide rates in the United States were 42.7 times higher than in the other countries. For US males, firearm homicide rates were 22.0 times higher, and for US females, firearm homicide rates were 11.4 times higher. The US firearm suicide rates were 5.8 times higher than in the other countries, though overall suicide rates were 30% lower. The US unintentional firearm deaths were 5.2 times higher than in the other countries. Among these 23 countries, 80% of all firearm deaths occurred in the United States, 86% of women killed by firearms were US women, and 87% of all children aged 0 to 14 killed by firearms were US children.

Conclusions: The United States has far higher rates of firearm deaths—firearm homicides, firearm suicides, and unintentional firearm deaths compared with other high-income countries. The US overall suicide rate is not out of line with these countries, but the United States is an outlier in terms of our overall homicide rate.

From the Department of Health Services (E.G.R.), UCLA School of Public Health, Los Angeles, California; and Harvard Injury Control Research Center (D.H.), Harvard School of Public Health, Boston, Massachusetts.

Submitted for publication October 26, 2009.

Accepted for publication March 2, 2010.

David Hemenway received partial support from the Joyce Foundation.

Address for reprints: Erin G. Richardson, S.M., Department of Health Services, UCLA School of Public Health, PO Box 951772, Los Angeles, CA 90095-1772; email:

© 2011 Lippincott Williams & Wilkins, Inc.