In 1990, firearm-related injuries surpassed motor-vehicle crashes as the leading cause of death from injuries in both Louisiana and Texas, and from 1979 through 1987, these states ranked third and fifth, respectively, for age-adjusted firearm-related death rates * (1). Because firearm-related injuries are a major cause of death in Louisiana and Texas, the Louisiana Disability Prevention Program, Louisiana Office of Public Health, and the Injury Control Program, Epidemiology Division, Texas Department of Health, used death certificates to examine patterns in firearm-related mortality. This report summarizes the analysis of death certificate data for firearm-related mortality in these two states. Louisiana

In Louisiana, firearm-related deaths have been the leading cause of injury-related mortality for 4 of the 5 years from 1986 through 1990. From 1970 through 1990, motor-vehicle-related death rates declined by 30% (from 32.4 per 100,000 population to 22.6 per 100,000) while the rate for firearm-related deaths fluctuated (Figure 1). Firearm-related death rates -- including homicide and suicide -- increased most for black males (42%) from 1970 through 1990 (from 54.1 per 100,000 to 76.7 per 100,000). Although the overall firearm-related death rate did not increase as dramatically among white males (16% during 1970-1990), the firearm-related suicide rate for white males increased 47%.

From 1985 through 1990, 5647 persons died as a result of firearm-related injuries; of these deaths, 2677 (47%) were suicides, 2591 (46%) were homicides, 321 (6%) were classified as unintentional, 19 (0.3%) resulted from legal intervention, and 39 (0.7%) were of unknown intent. In 1990, males were 5.5 times more likely to die from firearm-related injuries than were females (43.7 per 100,000 and 7.9 per 100,000, respectively); blacks were 2.2 times more likely to die from firearm-related injuries than were whites. Texas

During 1990, firearm-related injuries surpassed motor-vehicle crashes as the leading cause of injury-related mortality in Texas (2), the first state to report this pattern to CDC. From 1964 through 1989, deaths resulting from motor-vehicle crashes had been the leading cause of injury mortality in Texas. Although death rates for motor-vehicle crashes decreased by 42% from 1970 through 1990 (from 32.5 per 100,000 population to 18.8 per 100,000), the firearm-related death rate remained relatively constant (Figure 2).

From 1985 through 1990, 19,184 persons died from firearm-related injuries; of these deaths, 9286 (48%) were suicides, 8581 (45%) were homicides, 1028 (5%) were classified as unintentional, 114 (1%) resulted from legal intervention, and 175 (1%) were of unknown intent (2). Males were five times more likely to die from firearm-related injuries than were females (31.3 per 100,000 versus 6.2 per 100,000). Age-specific rates were highest for persons aged 25-34 years (28.9 per 100,000). Blacks were 1.9 times more likely to die from firearm-related injuries than were Hispanics or whites (32.3 per 100,000 versus 17.4 per 100,000 and 16.8 per 100,000, respectively). The firearm-related death rate was highest for black males (57.1 per 100,000).

Reported by: DW Lawrence, MPH, EAG Hooten, MSPH, JB Mathison, MD, Disability Prevention Program; LJ Hebert, MD, Office of Public Health, Louisiana Dept of Health and Hospitals. D Zane, MS, MJ Preece, Injury Control Program; P Patterson, MD, Family Health Svcs; E Svenkerud, MD, Epidemiology Div, D Perrotta, PhD, Environmental Epidemiologist, Texas Dept of Health. Div of Injury Control, National Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: The trends that led to the emergence of firearm-related deaths as the leading cause of injury-related mortality in Louisiana and Texas are similar to those for the United States. Since 1966, the death rate for motor-vehicle crashes ** in the United States has declined substantially (3) and has been associated with a combination of interventions, including the construction of safer highways and vehicles, reductions in the levels of alcohol-impaired driving, lower speed limits, and increased use of safety belts, motorcycle helmets, and child passenger restraint devices (4). In comparison, during 1970-1990, the firearm-related death rate has fluctuated; however, these rates have been higher than at any time since the 1920s (5).

States, local communities, and school systems have employed a variety of strategies to prevent firearm-related injuries and deaths. An important element of many of these strategies is to inhibit, restrict, or reduce immediate access to firearms in the general population or in specific locations. For example, in 1976, the District of Columbia banned the purchase, sale, transfer, or possession of handguns by civilians. An evaluation of this regulation found that it was associated with a 25% reduction in firearm-related homicides, a 23% reduction in firearm-related suicides, and an estimated 47 lives saved per year (6). In some states and localities, firearms are prohibited from being carried in public; in Detroit and in Massachusetts, legislation that increased the penalty for violating such laws reduced the occurrence of firearm-related homicides (7,8). In some school systems, methods used to deter students from bringing firearms on school grounds include random locker searches, walk-throughs with metal detectors, and policies requiring that students use only clear plastic or mesh bookbags so that weapons cannot be readily hidden (9).

Community efforts to prevent firearm-related deaths should use other measures in addition to reducing access to firearms. Suicide may be prevented by improved identification and referral of persons at increased risk (e.g., those suffering from clinical depression or who exhibit suicidal behavior). Efforts to prevent homicide may include reduction of the incidence of interpersonal violence through behavioral and other interventions (e.g., conflict resolution training and mentoring programs) (10). The reduction of mortality from motor-vehicle crashes in Louisiana and Texas illustrates how public health approaches can be used to control and prevent injury. The application of such approaches to firearm-related injury holds the potential for decreasing the morbidity and mortality associated with this problem.

References

1. CDC. Injury mortality atlas of the United States, 1979-1987. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1991.

2. Zane DF, Preece MJ, Patterson PJ, Svenkerud EK. Commentary: firearm-related mortality in Texas (1985-1990). Tex Med 1991;87:63-5.

3. National Highway Traffic Safety Administration. Fatal Accident Reporting System - 1990: a review of information on fatal traffic crashes in the United States. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1991; publication no. DOT-HS-807-794.

4. Transportation Research Board. Safety research for a changing highway environment. Washington, DC: National Research Council, 1990:13-35. (Special report no. 229).

5. Wintemute GJ. Firearms as a cause of death in the United States, 1920-1982. J Trauma 1987;27:532-6.

6. Loftin C, McDowall D, Wiersema B, Cottey TJ. Effects of restrictive licensing of handguns on homicide and suicide in the District of Columbia. N Engl J Med 1991;325:1615-20. 7. Deutsch SJ, Alt FB. The effect of the Massachusetts' gun control law on gun-related crimes in the city of Boston. Evaluation Quarterly 1977;1:543-68. 8. O'Carroll PW, Loftin C, Waller JB, et al. Preventing homicide: an evaluation of the efficacy of a Detroit gun ordinance. Am J Public Health 1991;81:576-81. 9. National School Safety Center. Weapons in schools -- NSSC resource paper. Malibu, California: National School Safety Center, 1990. 10. National Committee for Injury Prevention and Control. Injury prevention: meeting the challenge. New York: Oxford University Press, 1989.

• In both state analyses, a firearm-related death was defined as any death with the underlying cause listed as codes E922.0-E922.9, E955.0-E955.4, E965.0-E965.4, E970, or E985.0-E985.4 in the International Classification of Diseases (ICD), 8th and 9th revisions; a motor-vehicle-related death was defined as any death with the underlying cause listed as codes E810.0-E825.0 in the ICD, 8th and 9th revisions.

** Measured as deaths per 100 million vehicle miles of travel.

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