Firearm homicide mortality is influenced by structural racism in US metropolitan areas

J Trauma Acute Care Surg. 2021 Jul 1;91(1):64-71. doi: 10.1097/TA.0000000000003167.


Introduction: Metropolitan cities in the United States suffer from higher rates of gun violence. However, the specific structural factors associated with increased gun violence are poorly defined. We hypothesized that firearm homicide in metropolitan cities would be impacted by Black-White segregation index.

Methods: This cross-sectional analysis evaluated 51 US metropolitan statistical areas (MSAs) using data from 2013 to 2017. Several measures of structural racism were examined, including the Brooking Institute's Black-White segregation index. Demographic data were derived from the US Census Bureau, US Department of Education, and US Department of Labor. Crime data and firearm homicide mortality rates were obtained from the Federal Bureau of Investigation and the Centers for Disease Control. Spearman ρ and linear regression were performed.

Results: Firearm mortality was associated with multiple measures of structural racism and racial disparity, including White-Black segregation index, unemployment rate, poverty rate, single parent household, percent Black population, and crime rates. In regression analysis, percentage Black population exhibited the strongest association with firearm homicide mortality (β = 0.42, p < 0.001). Black-White segregation index (β = 0.41, p = 0.001) and percent children living in single-parent households (β = 0.41, p = 0.002) were also associated with higher firearm homicide mortality. Firearm legislation scores were associated with lower firearm homicide mortality (β = -0.20 p = 0.02). High school and college graduation rates were not associated with firearm homicide mortality and were not included in the final model.

Conclusion: Firearm homicide disproportionately impacts communities of color and is associated with measures of structural racism, such as White-Black segregation index. Public health interventions targeting gun violence must address these systemic inequities. Furthermore, given the association between firearm mortality and single-parent households, intervention programs for at-risk youth may be particularly effective.

Level of evidence: Epidemiological level II.

MeSH terms

  • Adolescent
  • Adult
  • Black or African American / statistics & numerical data
  • Cross-Sectional Studies
  • Female
  • Gun Violence / prevention & control
  • Gun Violence / statistics & numerical data*
  • Homicide / prevention & control
  • Homicide / statistics & numerical data*
  • Humans
  • Male
  • Racism / prevention & control
  • Racism / statistics & numerical data*
  • Socioeconomic Factors
  • United States / epidemiology
  • White People / statistics & numerical data
  • Wounds, Gunshot / mortality*
  • Wounds, Gunshot / prevention & control
  • Young Adult