The accessibility of firearms and risk for suicide and homicide victimization among household members: a systematic review and meta-analysis

Ann Intern Med. 2014 Jan 21;160(2):101-10. doi: 10.7326/M13-1301.


Background: Research suggests that access to firearms in the home increases the risk for violent death.

Purpose: To understand current estimates of the association between firearm availability and suicide or homicide.

Data sources: PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and Web of Science were searched without limitations and a gray-literature search was performed on 23 August 2013.

Study selection: All study types that assessed firearm access and outcomes between participants with and without firearm access. There were no restrictions on age, sex, or country.

Data extraction: Two authors independently extracted data into a standardized, prepiloted data extraction form.

Data synthesis: Odds ratios (ORs) and 95% CIs were calculated, although published adjusted estimates were preferentially used. Summary effects were estimated using random- and fixed-effects models. Potential methodological reasons for differences in effects through subgroup analyses were explored.Data were pooled from 16 [not 15] observational studies that assessed he odds of suicide or homicide, yielding pooled ORs of 3.24(95% CI, 2.41 to 4.40) and 2.00 (CI, 1.56 to 3.02) [not 1.94 (CI, .44 to 2.93)], respectively [corrected], respectively. When only studies that used interviews to determine firearm accessibility were considered, the pooled OR for suicide was 3.14 (CI, 2.29 to 4.43).

Limitations: Firearm accessibility was determined by survey interviews in most studies; misclassification of accessibility may have occurred. Heterogeneous populations of varying risks were synthesized to estimate pooled odds of death.

Conclusion: Access to firearms is associated with risk for completed suicide and being the victim of homicide.

Primary funding source: None.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Family Characteristics
  • Female
  • Firearms / statistics & numerical data*
  • Homicide / statistics & numerical data*
  • Humans
  • Male
  • Odds Ratio
  • Risk Factors
  • Suicide / statistics & numerical data*
  • United States