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 25-34, and the second-leading cause for those ages 15-24.1 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 45,000 Americans die each year from firearms, roughly the same number as die in motor vehicle crashes.1 In 2020, nearly three-fifths (24,292) of total firearm deaths were suicides and over two-fifths (19,384) were homicides. That year, half of suicides and four-fifths 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 20-24, the risk of being shot and killed for Black males is at least six times that of Hispanic males and 24 times that of white males.1
Firearm Homicide Rates for Males by Age and Race/Ethnicity, 2020
Data from CDC WISQARS.
Many structural inequities contribute to this disparity, including lack of economic and social opportunities, racial segregation, and historical and present policies and laws. Youth who live in cities 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 more than half of suicides nationally.1 Rates of firearm suicide are highest among white males, and this disparity increases with age. After age 50, the firearm suicide rate for white males is at least four times that for Black or Hispanic males.
Firearm Suicide Rates for Males by Age and Race/Ethnicity, 2020
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 45 and 49 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 13.1
Firearm Death Rates for Children and Adolescents by Age and Intent, 2020
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
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, 2019
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
For every person who dies from a firearm injury, another two survive. On average, over 85,000 nonfatal firearm injuries occur each year in the US, based on emergency department data.10 Half (51%) are unintentional injuries and 41% are caused by assault. Only a small percentage (3%) of nonfatal firearm injuries are due to self-harm, since almost 90% of self-inflicted firearm injuries result in death. Across intents, more than 3 in 4 patients treated for nonfatal firearm injuries are male. The total number of firearm-related injuries may in fact be higher, assuming some people receive treatment in other medical settings or don’t seek treatment at all.
Firearm injuries tend to be more severe and costly than other injuries, and are associated with more substantial continuing morbidity. For example, patients who survive firearm injuries are more likely than those injured in motor vehicle crashes to be hospitalized, admitted to an intensive care unit, and readmitted to the hospital after discharge. Mean hospital costs and lengths of stay per patient are also greater for firearm injuries than motor vehicle crashes.11,12
Firearm Deaths in California
In California in 2020, there were 3,350 deaths from firearms—about the average annual toll of recent years—of which 52% were homicides and 46% were suicides.1
Firearm Deaths by Intent in the US and California, 2020
Data from CDC WISQARS.
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.13 Though firearms are used in over half of all suicides nationally, firearm suicides in California are more rare, comprising about 36% of suicides.1
California Firearm Homicide and Suicide Rates by County, 2015
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.13 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 2019, California’s firearm homicide rate ranked 29th of the 50 states, and its firearm suicide rate ranked 44th of 50.1 Although its rates are relatively low, the state has a large burden of firearm death—more than 7% 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.14 The majority (70%) of those are assault injuries, with victims more likely to be younger men and men of color. Approximately one-quarter (24%) of nonfatal firearm injuries in California are unintentional, and 1% are due to self-harm.
Page last updated May 2022.
Click to view references
- Web-based Injury Statistics Query and Reporting System (WISQARS) [online].
- US Mass Shootings, 1982-2020: Data From Mother Jones’ Investigation.
- Predicting violent behavior: The role of violence exposure and future educational aspirations during adolescence. Journal of Adolescence.
- Suicide acts in 8 states: Incidence and case fatality rates by demographics and method. American Journal of Public Health.
- Violent death rates: The US compared with other high-income OECD countries, 2010. The American Journal of Medicine.
- The epidemiology of firearm violence in the twenty-first century United States. Annual Review of Public Health.
- Household firearm ownership and rates of suicide across the 50 United States. The Journal of Trauma.
- Firearm ownership and domestic versus nondomestic homicide in the U.S. American Journal of Preventive Medicine.
- The true cost of gun violence in America.
- Epidemiologic trends in fatal and nonfatal firearm injuries in the US, 2009-2017. JAMA Internal Medicine.
- Risk of 90-day readmission in patients after firearm injury hospitalization: a nationally representative cohort study. Journal of Injury and Violence Research.
- Comparison of cost and resource utilization between firearm injuries and motor vehicle collisions at pediatric hospitals. Academic Emergency Medicine.
- Firearm mortality in California, 2000–2015: The epidemiologic importance of within-state variation. Annals of Epidemiology.
- Incidence, distribution, and lethality of firearm injuries in California from 2005 to 2015. JAMA Network Open.
For more information, see these peer-reviewed articles.
Kaufman, E. J., Wiebe, D. J., Xiong, R. A., et al. (2020). Epidemiologic trends in fatal and nonfatal firearm injuries in the US, 2009-2017. JAMA Internal Medicine.
Hemenway, D. & Nelson, E. (2020). The scope of the problem: gun violence in the USA. Current Trauma Reports.
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.
Wintemute, G.J. (2015). The epidemiology of firearm violence in the twenty-first century United States. Annual Review of Public Health.
Additional Resources on the Epidemiology of Firearm-related Injury
Physicians and Firearms
Part one of an online course covering the epidemiology of gun violence. The curriculum is developed by medical students to bridge the gap in medical education to address gun violence as a public health epidemic.
Web-based Injury Statistics Query and Reporting System (WISQARS)
The Centers for Disease Control and Prevention, National Center for Injury Prevention and Control has created an interactive, online database, WISQARS, to compile data about fatal and nonfatal injury, violent death, and cost of injury. This database is accessible to the public.
Firearm Injury is a public health issue: here’s what you can do.
An informational video by Osmosis on the epidemiology of firearm-related injuries, its history in public health research, and what you can do.