Social determinants of health in relation to firearm-related homicides in the United States: A nationwide multilevel cross-sectional study
Social determinants of health in relation to firearm-related homicides in the United States: A nationwide multilevel cross-sectional study
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DOI：
10.1371/journal.pmed.1002978
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发表时间：
2019-12-01
期刊：
影响因子：
15.8
通讯作者：
Kim, Daniel
中科院分区：
文献类型：
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作者：
Kim, Daniel
背景枪支暴力缩短了美国人的平均预期寿命，更好地了解枪支暴力的根源对预防枪支暴力至关重要。虽然有一些经验证据表明社会和经济因素对暴力和火器杀人率的影响，但据作者所知，还没有对火器杀人和大规模枪击的主要社会健康决定因素进行全面和相对滞后的多层次调查。方法和结果本研究使用负二项回归模型和地理定位的枪支凶杀事件数据从2015年1月1日，到2015年12月31日，探索和比较健康的关键州，县和社区一级的社会决定因素的独立协会-社会流动性，社会资本，收入不平等，种族和经济隔离，和社会支出-与邻里枪支相关的凶杀案和大规模枪击案在美国，占相关的国家枪支法律和各种州，县，和邻里（人口普查区[CT]）的特点。枪支相关死亡的经纬度坐标先前由枪支暴力档案馆收集，然后由英国报纸《卫报》根据2010年人口普查地理位置与CT联系起来。研究人群包括美国48个州2010年人口普查定义的所有74，134名CT。最终样本涵盖70，579个CT，估计包含314，247，908人，占2015年美国总人口的98%。这些分析基于2015年13，060起与枪支有关的死亡事件，其中8，673个CT发生了11，244起非大规模枪击事件，138个CT发生了141起大规模枪击事件。对于地区一级的社会决定因素，3至17年的滞后期进行了研究，根据现有的理论，经验证据和数据的可用性。县级机构社会资本（对机构的信任程度），社会流动性，收入不平等和公共福利支出与CT级枪支杀人率以及非大规模和大规模枪击杀人事件的总数以及非大规模枪击杀人事件的总数表现出强有力的关系。机构社会资本增加1个标准差（SD）与凶杀率下降19%（发病率比[IRR] = 0.81，95%CI 0.73-0.91，p < 0.001）和枪支凶杀事件数量下降17%（IRR = 0.83，95%CI 0.73-0.95，p = 0.01）有关。向上的社会流动性与枪支杀人率下降25%（IRR = 0.75，95% CI 0.66-0.86，p < 0.001）和杀人事件数量下降24%（IRR = 0.76，95% CI 0.67-0.87，p < 0.001）有关。与此同时，贫困居民和独居男性的社区百分比增加1-SD分别与26%-27%和12%的凶杀率增加有关。研究的局限性包括个人/家庭层面因素可能造成的残余混杂，以及缺乏按性别和种族/民族分列的枪支杀人数据。结论本研究发现，贫富差距、公民对机构的信任程度、经济机会和公共福利支出都与美国的枪支杀人率有关。进一步建立这些关联的因果性质和修改这些社会决定因素可能有助于解决日益增长的枪支暴力流行病和扭转最近美国人的预期寿命下降。更好地了解枪支暴力的根源对于预防枪支暴力至关重要。虽然有一些经验证据表明社会和经济因素对暴力和火器杀人率的影响，但据作者所知，尚未对与火器杀人和大规模枪击有关的健康的主要社会决定因素进行全面和相对滞后的多层次调查。研究人员做了什么，发现了什么？这项研究使用了2015年美国地理位置的枪支杀人事件数据，探讨了美国州、县和社区一级健康的关键社会决定因素（社会流动性、社会资本、收入不平等、居住种族和经济隔离以及社会支出）与社区枪支杀人和大规模枪击事件的独立关联。研究人群包括美国48个州2010年人口普查定义的所有74，134个人口普查区（CT）。分析基于2015年13，060起与枪支有关的死亡事件，其中8，673个CT发生了11，244起非大规模枪击事件，138个CT发生了141起大规模枪击事件。使用3至17年的滞后期，县级机构社会资本，社会流动性，收入不平等和公共福利支出与CT级枪支凶杀率以及致命的非大规模和大规模枪击事件和非大规模枪击事件的数量之间存在着强有力的关系。这些发现意味着什么？这项研究发现，贫富差距、公民对机构的信任程度、经济机会和公共福利支出都与美国与枪支有关的杀人率和事件数量有关。建立这些关系的因果性质并修改这些社会决定因素可能有助于打击持续的枪支暴力流行病，并有助于扭转美国人最近预期寿命的下降。
Background Gun violence has shortened the average life expectancy of Americans, and better knowledge about the root causes of gun violence is crucial to its prevention. While some empirical evidence exists regarding the impacts of social and economic factors on violence and firearm homicide rates, to the author's knowledge, there has yet to be a comprehensive and comparative lagged, multilevel investigation of major social determinants of health in relation to firearm homicides and mass shootings. Methods and findings This study used negative binomial regression models and geolocated gun homicide incident data from January 1, 2015, to December 31, 2015, to explore and compare the independent associations of key state-, county-, and neighborhood-level social determinants of health-social mobility, social capital, income inequality, racial and economic segregation, and social spending-with neighborhood firearm-related homicides and mass shootings in the United States, accounting for relevant state firearm laws and a variety of state, county, and neighborhood (census tract [CT]) characteristics. Latitude and longitude coordinates on firearm-related deaths were previously collected by the Gun Violence Archive, and then linked by the British newspaper The Guardian to CTs according to 2010 Census geographies. The study population consisted of all 74,134 CTs as defined for the 2010 Census in the 48 states of the contiguous US. The final sample spanned 70,579 CTs, containing an estimated 314,247,908 individuals, or 98% of the total US population in 2015. The analyses were based on 13,060 firearm-related deaths in 2015, with 11,244 non-mass shootings taking place in 8,673 CTs and 141 mass shootings occurring in 138 CTs. For area-level social determinants, lag periods of 3 to 17 years were examined based on existing theory, empirical evidence, and data availability. County-level institutional social capital (levels of trust in institutions), social mobility, income inequality, and public welfare spending exhibited robust relationships with CT-level gun homicide rates and the total numbers of combined non-mass and mass shooting homicide incidents and non-mass shooting homicide incidents alone. A 1-standard deviation (SD) increase in institutional social capital was linked to a 19% reduction in the homicide rate (incidence rate ratio [IRR] = 0.81, 95% CI 0.73-0.91, p < 0.001) and a 17% decrease in the number of firearm homicide incidents (IRR = 0.83, 95% CI 0.73-0.95, p = 0.01). Upward social mobility was related to a 25% reduction in the gun homicide rate (IRR = 0.75, 95% CI 0.66-0.86, p < 0.001) and a 24% decrease in the number of homicide incidents (IRR = 0.76, 95% CI 0.67-0.87, p < 0.001). Meanwhile, 1-SD increases in the neighborhood percentages of residents in poverty and males living alone were associated with 26%-27% and 12% higher homicide rates, respectively. Study limitations include possible residual confounding by factors at the individual/household level, and lack of disaggregation of gun homicide data by gender and race/ethnicity. Conclusions This study finds that the rich-poor gap, level of citizens' trust in institutions, economic opportunity, and public welfare spending are all related to firearm homicide rates in the US. Further establishing the causal nature of these associations and modifying these social determinants may help to address the growing gun violence epidemic and reverse recent life expectancy declines among Americans.Author summaryWhy was this study done? Better knowledge about the root causes of gun violence is crucial to its prevention. While some empirical evidence exists regarding the impacts of social and economic factors on violence and firearm homicide rates, to the author's knowledge, there has yet to be a comprehensive and comparative lagged, multilevel investigation of major social determinants of health in relation to gun homicides and mass shootings. What did the researchers do and find? This study used geolocated gun homicide incident data from the US in 2015 to explore the independent associations of key state-, county-, and neighborhood-level social determinants of health-social mobility, social capital, income inequality, residential racial and economic segregation, and social spending-with neighborhood firearm homicides and mass shootings in the US. The study population consisted of all 74,134 census tracts (CTs) as defined for the 2010 Census in the 48 states of the contiguous US. Analyses were based on 13,060 firearm-related deaths in 2015, with 11,244 non-mass shootings taking place in 8,673 CTs and 141 mass shootings occurring in 138 CTs. Using lag periods of 3 to 17 years, county-level institutional social capital, social mobility, income inequality, and public welfare spending showed robust relationships with CT-level gun homicide rates and the numbers of combined fatal non-mass and mass shooting incidents and non-mass shooting incidents alone. What do these findings mean? This study finds that the rich-poor gap, levels of citizens' trust in institutions, economic opportunity, and public welfare spending are all associated with firearm-related homicide rates and incident counts in the US. Establishing the causal nature of these relationships and modifying these social determinants may help to combat the ongoing gun violence epidemic and aid in reversing recent life expectancy declines among Americans.