• Kristen R Choi, Altaf Saadi, Sae Takada, Molly C Easterlin, Liza S Buchbinder, David C Johnson, and Frederick J Zimmerman.
• National Clinician Scholars Program, Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA. krchoi@ucla.edu.
• J Gen Intern Med. 2020 Jul 1; 35 (7): 204320492043-2049.

BackgroundFirearm-related violence is a leading cause of mortality in the United States (US). Prior research suggests that public policy plays a role in firearm mortality, but the role of healthcare resources (physicians, insurance coverage) within the US policy context has not yet been studied.ObjectiveTo examine how healthcare resources and social/firearm policy affect firearm-related suicide and homicide rates in the US.DesignLongitudinal, ecological study.SettingUS.ParticipantsUS states from 2012 to 2016 (N = 242).MeasurementThe outcome variables were age-adjusted, firearm-related suicide and homicide rates. Predictor variables were healthcare resources (physicians, Medicaid benefits generosity) and policy context (social policy, firearm policy) with covariates for sociodemographic factors.ResultsHealthcare provider variables did not have significant associations to firearm-related suicide or homicide. In fully saturated models, more worker protection laws, greater average population density, more alcohol regulation, and more firearm prohibition policies were associated with fewer firearm-related suicides. Higher generosity of Medicaid benefits was associated with fewer firearm-related homicides. Poverty rate was a predictor of both outcomes.LimitationsThis state-level study cannot make individual-level inferences. Only proxy variables were available for measuring gun ownership and actual gun ownership rates may not have been ideally captured at the state level.ConclusionsAt the state level, there are protective associations of certain social, healthcare, and firearm policies to firearm-related suicide and homicide rates. Healthcare resources play a role in population-level firearm outcomes but alone are not sufficient to decrease firearm-related homicide or suicide.

13 keywords...

hide…