Global Burden of Disease 2016 Injury Collaborators , Naghavi M 1 , Marczak LB 1 , Kutz M 1 , Shackelford KA 1 , Arora M 1 Show all authors , Miller-Petrie M 1 , Aichour MTE 2 , Akseer N 3 , Al-Raddadi RM 4 , Alam K 5 , Alghnam SA 6 , Antonio CAT 7 , Aremu O 8 , Arora A 9 , Asadi-Lari M 10 , Assadi R 11 , Atey TM 12 , Avila-Burgos L 13 , Awasthi A 14 , Ayala Quintanilla BP 15 , Barker-Collo SL 16 , Bärnighausen TW 17 , Bazargan-Hejazi S 18 , Behzadifar M 19 , Behzadifar M 20 , Bennett JR 1 , Bhalla A 21 , Bhutta ZA 3 , Bilal AI 22 , Borges G 23 , Borschmann R 24 , Brazinova A 25 , Campuzano Rincon JC 26 , Carvalho F 27 , Castañeda-Orjuela CA 28 , Dandona L 1 , Dandona R 1 , Dargan PI 29 , De Leo D 30 , Dharmaratne SD 1 , Ding EL 31 , Phuc Do H 32 , Doku DT 33 , Doyle KE 34 , Driscoll TR 35 , Edessa D 36 , El-Khatib Z 37 , Endries AY 38 , Esteghamati A 39 , Faro A 40 , Farzadfar F 41 , Feigin VL 1 , Fischer F 42 , Foreman KJ 1 , Franklin RC 43 , Fullman N 1 , Futran ND 44 , Gebrehiwot TT 45 , Gutiérrez RA 46 , Hafezi-Nejad N 47 , Haghparast Bidgoli H 48 , Hailu GB 49 , Haro JM 50 , Hassen HY 51 , Hawley C 1 , Hendrie D 52 , Híjar M 53 , Hu G 54 , Ilesanmi OS 55 , Jakovljevic M 56 , James SL 1 , Jayaraman S 57 , Jonas JB 58 , Kahsay A 59 , Kasaeian A 60 , Keiyoro PN 61 , Khader Y 62 , Khalil IA 1 , Khang YH 63 , Khubchandani J 64 , Ahmad Kiadaliri A 65 , Kieling C 66 , Kim YJ 67 , Kosen S 68 , Krohn KJ 1 , Kumar GA 69 , Lami FH 70 , Lansingh VC 71 , Larson HJ 1 , Linn S 72 , Lunevicius R 73 , Magdy Abd El Razek H 74 , Magdy Abd El Razek M 75 , Malekzadeh R 76 , Carvalho Malta D 77 , Mason-Jones AJ 78 , Matzopoulos R 79 , Memiah PTN 80 , Mendoza W 81 , Meretoja TJ 82 , Mezgebe HB 83 , Miller TR 52 , Mohammed S 17 , Moradi-Lakeh M 84 , Mori R 85 , Nand D 86 , Tat Nguyen C 32 , Le Nguyen Q 32 , Ningrum DNA 87 , Akpojene Ogbo F 88 , Olagunju AT 89 , Patton GC 90 , Phillips MR 91 , Polinder S 92 , Pourmalek F 93 , Qorbani M 94 , Rahimi-Movaghar A 95 , Rahimi-Movaghar V 96 , Rahman M 97 , Rai RK 98 , Ranabhat CL 99 , Rawaf DL 100 , Rawaf S 101 , Rowhani-Rahbar A 102 , Safdarian M 103 , Safiri S 104 , Sagar R 105 , Salama JS 1 , Sanabria J 106 , Santric Milicevic MM 107 , Sarmiento-Suárez R 108 , Sartorius B 109 , Satpathy M 110 , Schwebel DC 111 , Seedat S 112 , Sepanlou SG 76 , Shaikh MA 113 , Sharew NT 114 , Shiue I 115 , Singh JA 116 , Sisay M 36 , Skirbekk V 117 , Soares Filho AM 118 , Stein DJ 119 , Stokes MA 120 , Sufiyan MB 121 , Swaroop M 122 , Sykes BL 123 , Tabarés-Seisdedos R 124 , Tadese F 125 , Tran BX 126 , Thanh Tran T 32 , Ukwaja KN 127 , Vasankari TJ 128 , Vlassov V 129 , Werdecker A 130 , Ye P 131 , Yip P 132 , Yonemoto N 133 , Younis MZ 134 , Zaidi Z 135 , El Sayed Zaki M 136 , Hay SI 1 , Lim SS 1 , Lopez AD 1 , Mokdad AH 1 , Vos T 1 , Murray CJL 1

Affiliations 

  • 1 Institute for Health Metrics and Evaluation, University of Washington, Seattle
  • 2 Higher National School of Veterinary Medicine, Algiers, Algeria
  • 3 Centre for Global Child Health, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
  • 4 Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
  • 5 School of Population and Global Health, University of Western Australia, Perth, WA, Australia
  • 6 Department of Population Health, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
  • 7 Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines
  • 8 Department of Public and Community Health, Birmingham City University, Birmingham, England
  • 9 School of Science and Health, Western Sydney University, Penrith, NSW, Australia
  • 10 Department of Epidemiology and Biostatistics, Iran University of Medical Sciences, Tehran, Iran
  • 11 Education Development Center, Mashhad University of Medical Sciences, Mashhad, Iran
  • 12 Department of Pharmacy, Mekelle University, Mekelle, Ethiopia
  • 13 Center of Health System Research, The National Institute of Public Health, Cuernavaca, Mexico
  • 14 Indian Institute of Public Health, Gandhinagar, India
  • 15 The Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
  • 16 School of Psychology, University of Auckland, Auckland, New Zealand
  • 17 Institute of Public Health, Heidelberg University, Heidelberg, Germany
  • 18 Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, California
  • 19 Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorranmabad, Iran
  • 20 Faculty of Health and Nutrition, Lorestan University of Medical Sciences, Khorranmabad, Iran
  • 21 Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • 22 School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
  • 23 Department of Epidemiology, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
  • 24 Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Melbourne, VIC, Australia
  • 25 Institute of Epidemiology, Comenius University, Bratislava, Slovakia
  • 26 National Institute of Health, Cuernavaca, Mexico
  • 27 Ucibio, Requimte, Faculty of Pharmacy, University of Porto, Porto, Portugal
  • 28 Colombian National Health Observatory, Instituto Nacional de Salud, Bogota, Colombia
  • 29 Department of Clinical Toxicology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
  • 30 Australian Institute for Suicide Research and Prevention, Griffith University, Mt Gravatt, QLD, Australia
  • 31 Harvard School of Public Health, Department of Nutrition, Harvard University, Boston, Massachusetts
  • 32 Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam
  • 33 Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
  • 34 School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University (RMIT), Bundoora, VIC, Australia
  • 35 Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
  • 36 School of Pharmacy, Haramaya University, Harar, Ethiopia
  • 37 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
  • 38 Department of Public Health, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
  • 39 Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • 40 Department of Psychology, Federal University of Sergipe, Sao Cristovao, Brazil
  • 41 Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • 42 Department of Public Health Medicine, Bielefeld University, Bielefeld, Germany
  • 43 College of Public Health Medical and Veterinary Science, James Cook University, Douglas, QLD, Australia
  • 44 School of Medicine Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle
  • 45 Department of Epidemiology and Biostatistics, Jimma University, Jimma, Ethiopia
  • 46 Epidemiological and Psychosocial Investigations, National Institute of Psychiatry Ramon de la Fuente, Mexico City, Mexico
  • 47 School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  • 48 Institute for Global Health, University College London, London, United Kingdom
  • 49 Biomedical Science Division, School of Medicine, Mekelle University, Mekelle, Ethiopia
  • 50 Research Unit, Parc Sanitari Sant Joan de Déu (CIBERSAM), Sant Boi de Llobregat, Spain
  • 51 Department of Public Health, Mizan-Tepi University, Mizan Teferi, Ethiopia
  • 52 School of Public Health, Curtin University, Bentley, Perth, WA, Australia
  • 53 Research Coordination, Fundación Entornos AC, Cuernavaca, Mexico
  • 54 Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
  • 55 Department of Public Health and Community Medicine, University of Liberia, Monrovia, Liberia
  • 56 Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
  • 57 Department of Surgery, Virginia Commonwealth University, Richmond
  • 58 Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
  • 59 Department of Nutrition and Dietetics, Mekelle University, Mekelle, Ethiopia
  • 60 Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • 61 School of Continuing and Distance Education, University of Nairobi, Nairobi, Kenya
  • 62 Public Health and Community Medicine, Jordan University of Science and Technology, Alramtha, Jordan
  • 63 Department of Health Policy and Management, College of Medicine, Seoul National University, Seoul, South Korea
  • 64 Department of Nutrition and Health Science, Ball State University, Muncie, Indiana
  • 65 Clinical Epidemiology Unit, Lund University, Lund, Sweden
  • 66 Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
  • 67 School of Medicine, Xiamen University Malaysia, Sepang, Malaysia
  • 68 Independent Consultant, Jakarta, Indonesia
  • 69 Public Health Foundation of India, Gurugram, India
  • 70 Department of Community and Family Medicine, Academy of Medical Science, Baghdad, Iraq
  • 71 Helpmesee, New York, New York
  • 72 School of Public Health, University of Haifa, Haifa, Israel
  • 73 General Surgery Department, Aintree University Hospital National Health Service Foundation Trust (NHS), Liverpool, United Kingdom
  • 74 Department of Cardiology, Damietta University, Damietta, Egypt
  • 75 Ophthalmology Department, Aswan Faculty of Medicine, Aswan, Egypt
  • 76 Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  • 77 Departamento Materno Infantil e Saúde Publica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  • 78 Department of Health Sciences, University of York, York, United Kingdom
  • 79 Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
  • 80 Department of Public Health, University of West Florida, Pensacola
  • 81 Peru Country Office, United Nations Population Fund (UNFPA), Lima, Peru
  • 82 Comprehensive Cancer Center, Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland
  • 83 School of Pharmacy, Academy of Medical Science, Baghdad, Iraq
  • 84 Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
  • 85 Department of Health Policy, National Center for Child Health and Development, Setagaya, Japan
  • 86 Health Information Unit, Ministry of Health, Suva, Fiji
  • 87 Public Health Department, Semarang State University, Kota Semarang, Indonesia
  • 88 Western Sydney University, Penrith, NSW, Australia
  • 89 School of Medicine, University of Adelaide, Adelaide, SA, Australia
  • 90 Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
  • 91 Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China
  • 92 Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
  • 93 School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
  • 94 Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
  • 95 Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
  • 96 Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • 97 Research and Evaluation Division, BRAC (Bangladesh Rehabilitation Assistance Committee), Dhaka, Bangladesh
  • 98 Society for Health and Demographic Surveillance, Suri, India
  • 99 Institute for Poverty Alleviation and International Development, Yonsei University, South Korea
  • 100 WHO Collaborating Centre for Public Health Education & Training, Imperial College London, London, United Kingdom
  • 101 Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
  • 102 Department of Epidemiology, University of Washington, Seattle
  • 103 Sina Trauma and Surgery Center, Iran University of Medical Sciences, Tehran, Iran
  • 104 Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
  • 105 Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
  • 106 Department of Surgery, Marshall University, Huntington, West Virginia
  • 107 Faculty of Medicine, Institute of Social Medicine, Centre School of Public Health and Health Management, University of Belgrade, Belgrade, Serbia
  • 108 Department of Health and Society, Faculty of Medicine, Universidad Ciencias Aplicadas y Ambientales, Bogotá, Colombia
  • 109 Department of Public Health Medicine, University of Kwazulu-Natal, Durban, South Africa
  • 110 UGC Centre of Advanced Study in Psychology, Utkal University, Bhubaneswar, India
  • 111 Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
  • 112 Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
  • 113 Independent Consultant, Karachi, Pakistan
  • 114 College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
  • 115 Instituts Für Medizinische Epidemiologie, Biometrie Und Informatik, Martin Luther University Halle-Wittenberg, Haale, Germany
  • 116 School of Medicine, University of Alabama at Birmingham
  • 117 Norwegian Institute of Public Health, Oslo, Norway
  • 118 Department of Diseases and Noncommunicable Diseases and Health Promotion, Federal Ministry of Health, Brasilia, Brazil
  • 119 South African Medical Research Council, Cape Town, South Africa
  • 120 School of Psychology, Deakin University, Burwood, VIC, Australia
  • 121 Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
  • 122 Department of Surgery, Northwestern University, Chicago, Illinois
  • 123 Department of Criminology, Law, & Society, University of California Irvine
  • 124 Department of Medicine, University of Valencia, Valencia, Spain
  • 125 Department of Public Health, Wollo University, Dessie, Ethiopia
  • 126 Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam
  • 127 Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria
  • 128 UKK Institute for Health Promotion Research, Tampere, Finland
  • 129 Department of Health Care Management and Economics, National Research University Higher School of Economics, Moscow, Russia
  • 130 Demographic Change and Ageing, Federal Institute for Population Research, Wiesbaden, Germany
  • 131 Division of Injury Prevention and Mental Health Improvement, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Xicheng District, China
  • 132 Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong SAR, China
  • 133 Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan
  • 134 Healthcare Management-Health Economics & Finance/Global Health, Jackson State University, Jackson, Missouri
  • 135 Department of Epidemiology, University Hospital of Setif, Setif, Algeria
  • 136 Faculty of Medicine, Mansoura University, Mansoura, Egypt
JAMA, 2018 08 28;320(8):792-814.
PMID: 30167700 DOI: 10.1001/jama.2018.10060

Abstract

Importance: Understanding global variation in firearm mortality rates could guide prevention policies and interventions.

Objective: To estimate mortality due to firearm injury deaths from 1990 to 2016 in 195 countries and territories.

Design, Setting, and Participants: This study used deidentified aggregated data including 13 812 location-years of vital registration data to generate estimates of levels and rates of death by age-sex-year-location. The proportion of suicides in which a firearm was the lethal means was combined with an estimate of per capita gun ownership in a revised proxy measure used to evaluate the relationship between availability or access to firearms and firearm injury deaths.

Exposures: Firearm ownership and access.

Main Outcomes and Measures: Cause-specific deaths by age, sex, location, and year.

Results: Worldwide, it was estimated that 251 000 (95% uncertainty interval [UI], 195 000-276 000) people died from firearm injuries in 2016, with 6 countries (Brazil, United States, Mexico, Colombia, Venezuela, and Guatemala) accounting for 50.5% (95% UI, 42.2%-54.8%) of those deaths. In 1990, there were an estimated 209 000 (95% UI, 172 000 to 235 000) deaths from firearm injuries. Globally, the majority of firearm injury deaths in 2016 were homicides (64.0% [95% UI, 54.2%-68.0%]; absolute value, 161 000 deaths [95% UI, 107 000-182 000]); additionally, 27% were firearm suicide deaths (67 500 [95% UI, 55 400-84 100]) and 9% were unintentional firearm deaths (23 000 [95% UI, 18 200-24 800]). From 1990 to 2016, there was no significant decrease in the estimated global age-standardized firearm homicide rate (-0.2% [95% UI, -0.8% to 0.2%]). Firearm suicide rates decreased globally at an annualized rate of 1.6% (95% UI, 1.1-2.0), but in 124 of 195 countries and territories included in this study, these levels were either constant or significant increases were estimated. There was an annualized decrease of 0.9% (95% UI, 0.5%-1.3%) in the global rate of age-standardized firearm deaths from 1990 to 2016. Aggregate firearm injury deaths in 2016 were highest among persons aged 20 to 24 years (for men, an estimated 34 700 deaths [95% UI, 24 900-39 700] and for women, an estimated 3580 deaths [95% UI, 2810-4210]). Estimates of the number of firearms by country were associated with higher rates of firearm suicide (P 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.