Association of County-Level Poverty and Inequities With Firearm-Related Mortality in US Youth
Association of County-Level Poverty and Inequities With Firearm-Related Mortality in US Youth
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DOI：
10.1001/jamapediatrics.2021.4822
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发表时间：
2022-01-01
期刊：
影响因子：
26.1
通讯作者：
Fleegler, Eric W.
中科院分区：
文献类型：
--
作者：
Barrett, Jefferson T.;Lee, Lois K.;Fleegler, Eric W.
在美国，与枪支有关的青少年死亡是一场公共卫生危机。县级贫困与青年枪支相关死亡风险之间的关联尚不清楚，然而，目的研究县级贫困集中与美国青年枪支相关死亡率之间的关联。设计、设置和参与者这项横断面研究分析了2007年1月1日至2010年1月12日期间发生的美国5至24岁儿童和年轻人的枪支死亡率。2016年12月31日数据来自疾病控制和预防中心的压缩死亡率文件，年度人口普查间隔县人口数据来自美国人口普查局。数据分析于2019年11月1日至2020年6月30日进行。EXPOSURES县级贫困分为5组：0%至4.9%，5%至9.9%，10%至14.9%，15%至19.9%，和>= 20%的人口生活在联邦贫困线以下。主要结果和措施主要结果是与枪支有关的死亡总数和具体目的（杀人，自杀和非故意）每10万青年在整个研究期间。多变量负二项回归模型被用来分析枪支相关的死亡率和县贫困集中度之间的关联，控制人口变量，城市化，全州枪支流行率。调整后的发病率比（IRR）进行了计算，全州枪支流行率进行了估计。结果分析了2007年至2016年67905例青年枪支相关死亡（主要由60164名男性组成[88.6%]）。在这些死亡中，42512人是他杀（62.6%），23034人是自杀（33.9%），1627人是无意的（2.4%）。与枪支有关的死亡风险随着县贫困集中度的增加而逐步增加。与贫困集中度最低的县相比，贫困集中度最高的县与枪支有关的总死亡率有所增加（调整后的IRR）。2.29; 95% CI，1.96-2.67）、杀人（校正IRR，3.55; 95% CI，2.80-4.51）、自杀（校正IRR，1.45; 95% CI，1.20-1.75）和意外死亡（校正IRR，9.32; 95% CI，2.32-37.4）。所有枪支相关死亡的PAF为0.51（95%CI，0.43-0.57），凶杀为0.66（95%CI，0.57-0.73），自杀为0.30（95%CI，0.17-0.42），非故意死亡为0.86（95%CI，0.46-0.97）。这一计算转化为34292枪支相关的死亡，就不会发生，如果所有县都有同样的风险，县贫困集中度最低。共3 833 105年的潜在寿命lossed.CONCLUSIONS和相关性这项研究发现，枪支相关的死亡率之间的关联青年和县级贫困集中。由于一半以上与枪支有关的死亡和三分之二与枪支有关的杀人可能与生活在贫困高度集中的地区有关，迫切需要一项多层面战略来减少贫困和与枪支有关的死亡。
IMPORTANCE Youth firearm-related deaths are a public health crisis in the US. The association between county-level poverty and the risk of firearm-related deaths among youth is unknown, however.OBJECTIVE To examine the association between county-level poverty concentration and firearm-related mortality rates in US youth.DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed US firearm fatalities in children and young adults aged 5 to 24 years that occurred between January 1, 2007, and December 31, 2016. Data were obtained from the Centers for Disease Control and Prevention's Compressed Mortality File, and annual intercensal county population data were obtained from the US Census Bureau. Data analyses were conducted between November 1, 2019, and June 30, 2020.EXPOSURES County-level poverty was categorized into 5 groups: 0% to 4.9%, 5% to 9.9%, 10% to 14.9%, 15% to 19.9%, and >= 20% of the population living below the federal poverty level.MAIN OUTCOMES AND MEASURES The main outcomes were firearm-related deaths in total and by specific intent (homicide, suicide, and unintentional) per 100 000 youths over the entire study period. Multivariable negative binomial regression models were used to analyze the association between firearm-related mortality rates and county poverty concentration, controlling for demographic variables, urbanicity, and statewide firearm prevalence. Adjusted incidence rate ratios (IRRs) were calculated, and statewide firearm prevalence was estimated. The population-attributable fraction (PAF) and years of potential life lost for each intent were calculated.RESULTS A total of 67 905 firearm-related deaths among youth (predominantly composed of 60 164 male individuals [88.6%)) from 2007 to 2016 were analyzed. Of these deaths, 42 512 were homicides (62.6%), 23 034 were suicides (33.9%), and 1627 were unintentional (2.4%). Firearm-related mortality risk increased in a stepwise manner with increasing county poverty concentration. Compared with counties with the lowest poverty concentration, counties with the highest poverty concentration had an increased rate of total firearm-related deaths (adjusted IRR. 2.29; 95% CI, 1.96-2.67), homicides (adjusted IRR, 3.55; 95% CI, 2.80-4.51), suicides (adjusted IRR, 1.45; 95% CI, 1.20-1.75), and unintentional deaths (adjusted IRR, 9.32; 95% CI, 2.32-37.4). The PAF was 0.51(95% CI, 0.43-0.57) for all firearm-related deaths, 0.66 (95% CI, 0.57-0.73) for homicides, 0.30 (95% CI, 0.17-0.42) for suicides, and 0.86 (95% CI, 0.46-0.97) for unintentional deaths. This calculation translated to 34292 firearm-related deaths that would not have occurred if all counties had the same risk as counties with the lowest poverty concentration. A total of 3 833 105 years of potential life lost was observed.CONCLUSIONS AND RELEVANCE This study found an association between firearm-related mortality rates among youth and county-level poverty concentration. With more than half of firearm-related deaths and two-thirds of firearm-related homicides potentially associated with living in an area with a high concentration of poverty, a multidimensional strategy to reduce poverty and firearm-related deaths is urgently needed.