Food Insecurity Predicts Urban Gun Violence

Am Surg. 2020 Sep;86(9):1067-1072. doi: 10.1177/0003134820942194. Epub 2020 Aug 11.


Introduction: Food insecurity (FI), defined as inadequate access to affordable and quality nutrition, has negative health consequences. FI and violence share similar root causes. The aim of this study was to determine the association of FI with gunshot injury (GSI) incidence.

Methods: We performed a retrospective review of all patients from 2012 to 2018 who sustained a GSI. Food access data was abstracted from the US Department of Agriculture. We analyzed the impact of FI, low food access (LA), and low food access with no vehicle (LANV) on the incidence of GSI using Poisson regression. We also compared high-risk zip codes for GSI, FI, LA, and LANV using geospatial analysis.

Results: There were 1700 patients in our cohort from 33 different zip codes. The median incidence of GSI per zip code was 142 (85-164); 5 zip codes comprised 50% of all GSI events. FI (incidence rate ratio [IRR] 4.05, 95% CI 3.98-4.13, P < .0001), LA (IRR 2.97, 95% CI 2.92-3.03. P < .0001), and LANV (IRR 2.58, 95% CI 2.55-2.62, P < .0001) were significant predictors of GSI incidence. The FI model was superior to the LA and LANV models. Geospatial analysis demonstrated that both FI (P < .0001) and LANV (P < .0001) were significantly associated with GSI, while LA was not (P > .05).

Conclusion: FI is an independent risk factor for GSI incidence. Additionally, a majority of GSI events occur in a minority of communities. These data provide a novel opportunity for social services to guide future violence prevention strategies.

Keywords: food insecurity; gunshot injury; urban population.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Female
  • Follow-Up Studies
  • Food Supply / statistics & numerical data*
  • Gun Violence / statistics & numerical data*
  • Humans
  • Incidence
  • Male
  • Retrospective Studies
  • Risk Factors
  • United States / epidemiology
  • Wounds, Gunshot / epidemiology*
  • Wounds, Gunshot / prevention & control
  • Young Adult