Epidemiology

Risk of firearm-related harm varies by demographics, geography, and other factors

Firearm injury is a major public health issue, causing premature death, long-term physical and emotional disability, significant direct emergency and medical expenses, and economic costs to society.

Firearms are the leading cause of death for Americans ages 15-24, and the second-leading cause for those ages 25-34.1 Firearm-related harm is disproportionately distributed across demographic groups: older white males have the highest rates of firearm suicide, while rates of homicide and interpersonal firearm injury are highest among younger Black males. Rates of firearm death also vary according to geographic region, urban-rural status, and socioeconomic and structural inequity.

Firearm Death in the United States

Nearly 40,000 Americans die each year from firearms, roughly the same number as die in motor vehicle crashes.1 In 2018, nearly two-thirds (24,432) of total firearm deaths were suicides and over one-third (13,958) were homicides. That year, half of suicides and nearly three-quarters of homicides were by firearm.

Although public mass shootings garner much media and political attention, they account for less than 1% of all firearm deaths nationwide each year.1,2

Firearm homicide rates have been on the rise in the US since 2014. Young Black males are at highest risk of death by firearm homicide: at ages 20-29, the risk of being shot and killed for Black males is at least five times that of Hispanic males and 20 times that of white males.1

Death Rates from Firearm Homicide for Males by Age, 2018

Data from CDC WISQARS. Homicides include deaths by legal intervention.

Many structural inequities contribute to this disparity, including lack of economic and social opportunities, racial segregation, and historical and present policies and laws. Urban youth and Black youth are more likely to be exposed to community violence than their counterparts, and being a victim of or witness to violence is correlated with perpetrating violence in the future.3

Suicide rates have been rising since 2006, and firearms continue to account for about half of suicides nationally.1 Rates of firearm suicide are highest among white males, and this disparity increases with age. After age 45, the firearm suicide rate for white males is at least three times that for Black or Hispanic males.

Death Rates from Firearm Suicide for Males by Age, 2018

Data from CDC WISQARS.

Older white men attempt suicide less often but have a higher rate of death compared to younger adults, women, and other racial/ethnic groups.4 This is likely because they have the highest prevalence of firearm ownership and are more likely to attempt with a gun.

Females’ rates of both firearm suicide and homicide are substantially lower (by roughly 80% to 90%) than rates for males.1 Nonetheless, racial disparities persist. Young Black females have higher rates of firearm homicide than white males of the same age, but only about one-tenth the rate of young Black males. The rate of firearm suicide for white females peaks between ages 50 and 54 but is less than 25% that for white males of the same age group.

Children and adolescents are also at risk of dying by suicide and interpersonal violence with firearms: rates of firearm homicide and firearm suicide begin to steadily increase around age 12.1

Death Rates from Firearms for Children by Age, 2018

Data from CDC WISQARS.

Clinicians should recognize that children, even at age 12 or younger, can be suicidal and may have access to firearms. In a study of four US states and two metropolitan counties, it was estimated that 85% of adolescents who died by suicide with a firearm used a gun that belonged to a family member.4

Geographic Variation

The United States has a uniquely high rate of firearm death, on average 10 times higher than that of comparable high-income countries.5 Even though US rates of overall interpersonal violence are relatively low, the firearm homicide rate is 25 times higher than the average of comparable nations.5,6

Age-Adjusted Firearm Homicide & Suicide Rates by State, 2018

Data from CDC WISQARS. Homicide rates for ME, NH, ND, RI, SD, VT, and WY may be unstable. Homicides include deaths by legal intervention.

Within the US, firearm homicide and suicide rates vary demographically and geographically. Rural intermountain states, like Wyoming and Montana, have relatively high rates of firearm suicide and low rates of homicide, while states in the South have disproportionately high rates of firearm homicide and about average rates of firearm suicide.1 Evidence suggests that states where more people own guns have higher rates of firearm suicide and higher rates of domestic (family or intimate partner) homicides, but not non-domestic homicides.7,8

The US spends an unprecedented amount on firearm violence: the annual cost is estimated to be $229 billion.9 Direct costs are an estimated $8.6 billion; this is spent on emergency and medical services, police investigation, and court and prison costs after someone is shot. The other $221 billion are in indirect costs, including $49 billion annually for victims’ lost wages and $169 billion for the impacts on victims’ quality of life.

Firearm-Related Injuries in the US

According to the National Criminal Victimization Survey, nearly 80,000 people sustained injuries from a violent incident (i.e., robbery, aggravated assault, rape or sexual assault) involving a firearm in 2018.10 This does not include people who sustained firearm-related injuries due to a suicide attempt or unintentional shooting. That year, another 391,818 people were victimized with a firearm but did not sustain bodily injuries.

Firearm Deaths in California

In California in 2018, there were 3,040 deaths from firearms—about the average annual toll of recent years—of which 45% were homicides and 53% were suicides.1

Firearm Deaths by Intent in the US and California, 2018

Data from CDC WISQARS. Homicides include deaths by legal intervention.

California’s homicide and suicide rates vary by region. Reflecting national patterns, the more rural northern counties have higher rates of firearm suicide compared to urban areas like Los Angeles and San Francisco.11 Though firearms are used in over half of all suicides nationally, firearm suicides in California are more rare, comprising about 37% of suicides.

California Firearm Homicide and Suicide Rates by County, 2015

From Pear et al. (2018) in Annals of Epidemiology.

Firearm homicide rates in California, which fell in the early 2000s and began to increase again in 2015, are highest in the San Joaquin Valley.11 Los Angeles County, where one-quarter of California’s population resides, drove that initial decrease: the firearm homicide rate there declined by 54% from 2002 to 2015, which was the end of the study period, primarily due to a reduction in firearm homicides among Hispanic men.

In 2018, California’s firearm homicide rate ranked 29th of the 50 states, and its firearm suicide rate ranked 45th of 50.1 Although its rates are relatively low, the state has a large burden of firearm death—nearly 8% of firearm deaths in the country—because of its large population.

California’s Firearm-Related Injuries

On average, there are more than 7,000 nonfatal firearm injuries in California each year.12 The majority of those are assault injuries, with victims more likely to be younger men and men of color. Approximately one-quarter of nonfatal firearm injuries in California are unintentional.

Click to view references

  1. Centers for Disease Control and Prevention, National Centers for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online].
  2. Follman M., Aronsen G., Pan, D. (2020). US Mass Shootings, 1982-2020: Data From Mother Jones’ Investigation.
  3. Stoddard, S. A., Heinze, J. E., Choe, D. E., et al. (2015). Predicting violent behavior: The role of violence exposure and future educational aspirations during adolescence. Journal of Adolescence.
  4. Spicer, R. S., & Miller, T. R. (2000). Suicide acts in 8 states: Incidence and case fatality rates by demographics and method. American Journal of Public Health.
  5. Grinshteyn, E. G., & Hemenway, D. (2016). Violent Death Rates: The US Compared with Other High-income OECD Countries, 2010. The American Journal of Medicine.
  6. Wintemute, G. J. (2015). The epidemiology of firearm violence in the twenty-first century United States. Annual Review of Public Health.
  7. Miller, M., Lippmann, S. J., Azrael, D., et al. (2007). Household firearm ownership and rates of suicide across the 50 United States. The Journal of Trauma.
  8. Kivisto, A. J., Magee, L. A., Phalen, P. L., et al. (2019). Firearm Ownership and Domestic Versus Nondomestic Homicide in the U.S. American Journal of Preventive Medicine.
  9. Follman M., Lurie J., Lee J., West J. (2015). The true cost of gun violence in America.
  10. Bureau of Justice Statistics. NCVS Victimization Analysis Tool. Number of violent victimizations by injury and weapon category, 2010-2018.
  11. Pear, V. A., Castillo-Carniglia, A., Kagawa, R. M., et al. (2018). Firearm mortality in California, 2000–2015: The epidemiologic importance of within-state variation. Annals of Epidemiology.
  12. Spitzer, S. A., Pear, V. A., McCort, C. D., et al. (2020). Incidence, Distribution, and Lethality of Firearm Injuries in California From 2005 to 2015. JAMA Network Open.
For more information, see these peer-reviewed articles.

Pear, V. A., Castillo-Carniglia, A., Kagawa, R. M., et al. (2018). Firearm mortality in California, 2000–2015: The epidemiologic importance of within-state variation. Annals of Epidemiology.

Rivara, F.P., Studdert, D.M., Wintemute, G.J. (2018). Firearm-Related Mortality: A Global Public Health Problem. JAMA.

Grinshteyn, E. G., & Hemenway, D. (2016). Violent Death Rates: The US Compared with Other High-income OECD Countries, 2010. The American Journal of Medicine.

Wintemute, G.J. (2015). The Epidemiology of Firearm Violence in the Twenty-first Century United States. Annual Review of Public Health.

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