Urban-rural shifts in intentional firearm death: different causes, same results

Am J Public Health. 2004 Oct;94(10):1750-5. doi: 10.2105/ajph.94.10.1750.


Objectives: We analyzed urban-rural differences in intentional firearm death.

Methods: We analyzed 584629 deaths from 1989 to 1999 assigned to 3141 US counties, using negative binomial regressions and an 11-category urban-rural variable.

Results: The most urban counties had 1.03 (95% confidence interval [CI]=0.87, 1.20) times the adjusted firearm death rate of the most rural counties. The most rural counties experienced 1.54 (95% CI=1.29, 1.83) times the adjusted firearm suicide rate of the most urban. The most urban counties experienced 1.90 (95% CI=1.50, 2.40) times the adjusted firearm homicide rate of the most rural. Similar opposing trends were not found for nonfirearm suicide or homicide.

Conclusions: Firearm suicide in rural counties is as important a public health problem as firearm homicide in urban counties. Policymakers should become aware that intentional firearm deaths affect all types of communities in the United States.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Homicide / statistics & numerical data
  • Humans
  • Regression Analysis
  • Rural Population / statistics & numerical data*
  • Suicide / statistics & numerical data
  • United States / epidemiology
  • Urban Population / statistics & numerical data*
  • Wounds and Injuries / mortality
  • Wounds, Gunshot / mortality*