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Legislating mortality – firearm law impact

June 15, 2016

Short Attention Span Summary

I know this is a hot button issue, but in light of the recent mass shooting in Orlando this article from March in the Lancet is timely.  Authors concluded that universal background checks for firearm purchases would decrease firearm related mortality from the current 10.35 deaths/100,000 to 4.46 deaths/100,000.  Before we get too excited, there are serious questions about the statistical validity of the study, and this article in the Washington Post is worth reading.  In Tennessee, if you buy a .22 rifle at the local big box store, you have to undergo (and pay for) a background check.  So this is not a new law in most states.  The issue is universal enforcement, such as at gun shows.  If the study results are true, which is suspect, this represents 6 people – whose lives matter – who would not be killed simply by enforcing existing law.  It seems like a such a simple solution – universally enforcing existing law.  No matter your political leaning, this article is important to know.

FOAM Report


Lancet. 2016 Apr 30;387(10030):1847-55. doi: 10.1016/S0140-6736(15)01026-0. Epub 2016 Mar 11.

Firearm legislation and firearm mortality in the USA: a cross-sectional, state-level study.

Kalesan B1, Mobily ME2, Keiser O3, Fagan JA4, Galea S5.

Author information:

1Department of Medicine, Boston University, Boston, MA, USA. Electronic address: kalesan@bu.edu.

2Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.

3Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.

4Columbia Law School and Department of Epidemiology, Columbia University, New York, NY, USA.

5School of Public Health, Boston University, Boston, MA, USA.

Comment in



In an effort to reduce firearm mortality rates in the USA, US states have enacted a range of firearm laws to either strengthen or deregulate the existing main federal gun control law, the Brady Law. We set out to determine the independent association of different firearm laws with overall firearm mortality, homicide firearm mortality, and suicide firearm mortality across all US states. We also projected the potential reduction of firearm mortality if the three most strongly associated firearm laws were enacted at the federal level.


We constructed a cross-sectional, state-level dataset from Nov 1, 2014, to May 15, 2015, using counts of firearm-related deaths in each US state for the years 2008-10 (stratified by intent [homicide and suicide]) from the US Centers for Disease Control and Prevention’s Web-based Injury Statistics Query and Reporting System, data about 25 firearm state laws implemented in 2009, and state-specific characteristics such as firearm ownership for 2013, firearm export rates, and non-firearm homicide rates for 2009, and unemployment rates for 2010. Our primary outcome measure was overall firearm-related mortality per 100,000 people in the USA in 2010. We used Poisson regression with robust variances to derive incidence rate ratios (IRRs) and 95% CIs.


31,672 firearm-related deaths occurred in 2010 in the USA (10·1 per 100,000 people; mean state-specific count 631·5 [SD 629·1]). Of 25 firearm laws, nine were associated with reduced firearm mortality, nine were associated with increased firearm mortality, and seven had an inconclusive association. After adjustment for relevant covariates, the three state laws most strongly associated with reduced overall firearm mortality were universal background checks for firearm purchase (multivariable IRR 0·39 [95% CI 0·23-0·67]; p=0·001), ammunition background checks (0·18 [0·09-0·36]; p<0·0001), and identification requirement for firearms (0·16 [0·09-0·29]; p<0·0001). Projected federal-level implementation of universal background checks for firearm purchase could reduce national firearm mortality from 10·35 to 4·46 deaths per 100,000 people, background checks for ammunition purchase could reduce it to 1·99 per 100,000, and firearm identification to 1·81 per 100,000.


Very few of the existing state-specific firearm laws are associated with reduced firearm mortality, and this evidence underscores the importance of focusing on relevant and effective firearms legislation. Implementation of universal background checks for the purchase of firearms or ammunition, and firearm identification nationally could substantially reduce firearm mortality in the USA.



Copyright © 2016 Elsevier Ltd. All rights reserved.

PMID: 26972843 [PubMed – indexed for MEDLINE]

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