Data from a surveillance study demonstrate large state-to-state variation in firearm homicide and suicide rates as well as racial inequalities in these rates, according to the results of a study published in the Annals of Internal Medicine. These data highlight states in which policies have the potential to reduce deaths from homicide and suicide, as well as racial disparities in their rates.

In the United States in 2016, black men were approximately 10 times more likely to die by homicide and 14 times more likely to die by firearm homicide than white men; white men were 2.5 times more likely than black men to die by suicide. Approximately 80% of homicides and 60% of suicides involve firearms.

Corinne A. Riddell, PhD, from the Department of Epidemiology, Biostatistics, and Occupation Health, McGill University, Montreal, Quebec, Canada, and colleagues used the Centers for Disease Control and Prevention’s WONDER (Wide-Ranging Online Data for Epidemiologic Research) database to compare the rates of firearm and nonfirearm homicide and suicide in black and white non-Hispanic men by US state and to determine the association of those deaths with state prevalence of gun ownership between 2008 and 2016.

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Over the course of the 9-year study, 84,113 homicides and 251,772 suicides occurred. Black men had between 9 and 57 additional firearm homicides per 100,000 per year compared with white men. In 5 states (Missouri, Michigan, Illinois, Indiana, and Pennsylvania), black men had 40 additional firearm homicides per 100,000 per year. White men had between 2 fewer and 16 more firearm suicides per 100,000 per year. The greatest inequalities for these suicides occurred in southern and western states, and the smallest were in the District of Columbia and the Northeast.

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The states with the lowest firearm homicide and suicide in white men (Massachusetts, New Jersey, Rhode Island, New York, and Connecticut) were also in the lowest category of state gun prevalence. Likewise, many states with the highest firearm homicide and suicide rates had the highest prevalence of gun ownership. However, several states that fell in the highest category of gun prevalence had relatively low rates of firearm homicide, including Iowa, Nebraska, the Dakotas, Idaho, Montana, and Wyoming.

Limitations of this study include the possibility that some homicides and suicides may have been misclassified as deaths resulting from unintentional injury, and that survey data on state gun ownership were collected in 2004 and may have changed during the last decade.

The authors point out the wide variation in black homicide rates across southern and rust belt states with similar levels of gun ownership, and suggest that these warrant further investigation. They suggest that multilevel models might help explain some of the reasons for variations in homicide and suicide rates across states.


Riddell CA, Harper S, Cerda M, Kaufman JS. Comparison of rates of firearm and nonfirearm homicide and suicide in black and white non-Hispanic men, by US state. Ann Intern Med. 2018;168:712-720.