Longitudinal Associations Between Healthcare Resources, Policy, and Firearm-Related Suicide and Homicide from 2012 to 2016

J Gen Intern Med. 2020 Jul;35(7):2043-2049. doi: 10.1007/s11606-019-05613-3. Epub 2020 Jan 2.

Abstract

Background: Firearm-related violence is a leading cause of mortality in the United States (US). Prior research suggests that public policy plays a role in firearm mortality, but the role of healthcare resources (physicians, insurance coverage) within the US policy context has not yet been studied.

Objective: To examine how healthcare resources and social/firearm policy affect firearm-related suicide and homicide rates in the US.

Design: Longitudinal, ecological study.

Setting: US.

Participants: US states from 2012 to 2016 (N = 242).

Measurement: The outcome variables were age-adjusted, firearm-related suicide and homicide rates. Predictor variables were healthcare resources (physicians, Medicaid benefits generosity) and policy context (social policy, firearm policy) with covariates for sociodemographic factors.

Results: Healthcare provider variables did not have significant associations to firearm-related suicide or homicide. In fully saturated models, more worker protection laws, greater average population density, more alcohol regulation, and more firearm prohibition policies were associated with fewer firearm-related suicides. Higher generosity of Medicaid benefits was associated with fewer firearm-related homicides. Poverty rate was a predictor of both outcomes.

Limitations: This state-level study cannot make individual-level inferences. Only proxy variables were available for measuring gun ownership and actual gun ownership rates may not have been ideally captured at the state level.

Conclusions: At the state level, there are protective associations of certain social, healthcare, and firearm policies to firearm-related suicide and homicide rates. Healthcare resources play a role in population-level firearm outcomes but alone are not sufficient to decrease firearm-related homicide or suicide.

Publication types

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

MeSH terms

  • Delivery of Health Care
  • Firearms*
  • Homicide
  • Humans
  • Suicide Prevention*
  • United States / epidemiology
  • Violence
  • Wounds, Gunshot* / epidemiology
  • Wounds, Gunshot* / prevention & control