• Corinne A Riddell, Sam Harper, Magdalena Cerdá, and Jay S Kaufman.
• McGill University, Montreal, Quebec, Canada (C.A.R., S.H., J.S.K.).
• Ann. Intern. Med. 2018 May 15; 168 (10): 712-720.

BackgroundThe extent to which differences in homicide and suicide rates in black versus white men vary by U.S. state is unknown.ObjectiveTo compare the rates of firearm and nonfirearm homicide and suicide in black and white non-Hispanic men by U.S. state and to examine whether these deaths are associated with state prevalence of gun ownership.DesignSurveillance study.Setting50 states and the District of Columbia, 2008 to 2016. Cause-of-death data were abstracted by using the Centers for Disease Control and Prevention's WONDER (Wide-ranging Online Data for Epidemiologic Research) database.ParticipantsNon-Hispanic black and non-Hispanic white males, all ages.MeasurementsAbsolute rates of and rate differences in firearm and nonfirearm homicide and suicide in black and white men.ResultsDuring the 9-year study period, 84 113 homicides and 251 772 suicides occurred. Black-white differences in rates of firearm homicide and suicide varied widely across states. Relative to white men, black men had between 9 and 57 additional firearm homicides per 100 000 per year, with black men in Missouri, Michigan, Illinois, Indiana, and Pennsylvania having more than 40 additional firearm homicides per 100 000 per year. White men had between 2 fewer and 16 more firearm suicides per 100 000 per year, with the largest inequalities observed in southern and western states and the smallest in the District of Columbia and densely populated northeastern states.LimitationsSome homicides and suicides may have been misclassified as deaths due to unintentional injury. Survey data on state household gun ownership were collected in 2004 and may have shifted during the past decade.ConclusionThe large state-to-state variation in firearm homicide and suicide rates, as well as the racial inequalities in these numbers, highlights states where policies may be most beneficial in reducing homicide and suicide deaths and the racial disparities in their rates.Primary Funding SourceMcGill University and the National Institutes of Health.

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