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Modifiable Factors Related to Firearm Homicides: A Broader View of our Lane.

OBJECTIVE
This study aims to identify modifiable factors related to firearm homicide (FH).


SUMMARY BACKGROUND DATA
Many socioeconomic, legislative and behavioral risk factors impact FH. Most studies have evaluated these risk factors in isolation, but they coexist in a complex and ever-changing American society. We hypothesized that both restrictive firearm laws and socioeconomic support would correlate with reduced FH rates.


METHODS
To perform our ecologic cross-sectional study, we queried the Centers for Disease Control (CDC) Wide-ranging ONline Data for Epidemiologic Research (WONDER) and Federal Bureau of Investigation (FBI) Uniform Crime Reporting (UCR) for 2013-2016 state FH data. We retrieved firearm access estimates from the RAND State-Level Firearm Ownership Database. Alcohol use and access to care data were captured from the CDC Behavioral Risk Factor Surveillance System (BRFSS). Detached youth rates, socioeconomic support data and poverty metrics were captured from US Census data for each state in each year. Firearm laws were obtained from the State Firearms Law Database. Variables with significant FH association were entered into a final multivariable panel linear regression with fixed effect for state.


RESULTS
A total of 49,610 FH occurred in 2013-2016 (median FH rate: 3.9:100,000, range: 0.07-11.2). In univariate analysis, increases in concealed carry limiting laws (P=0.012), detached youth rates (P<0.001), socioeconomic support (P<0.001) and poverty rates (P<0.001) correlated with decreased FH. Higher rates of heavy drinking (P=0.036) and the presence of stand your ground doctrines (P=0.045) were associated with increased FH. Background checks, handgun limiting laws, and weapon access were not correlated with FH. In multivariable regression, increased access to food benefits for those in poverty [β: -0.132, 95% confidence interval (CI): -0.182 to -0.082, P<0.001] and laws limiting concealed carry (β: -0.543, 95% CI: -0.942 to -0.144, P=0.008) were associated with decreased FH rates. Allowance of stand your ground was associated with more FHs (β: 1.52, 95% CI: 0.069-2.960, P<0.040).


CONCLUSIONS
The causes and potential solutions to FH are complex and closely tied to public policy. Our data suggests that certain types of socioeconomic support and firearm restrictive legislation should be emphasized in efforts to reduce firearm deaths in America.