• Berna Buyukozturk, Joanna Drowos, Charles H Hennekens, Maria C Mejia de Grubb, Jason L Salemi, and Robert S Levine.
• From the Departments of Integrated Medical Science, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, and the Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas.
• South. Med. J. 2018 Oct 1; 111 (10): 607-611.

ObjectiveDescribe southern US homicide rates in whites and blacks between 1999 and 2015.MethodsThe Centers for Disease Control and Prevention Multiple Cause of Death Files provided mortality rates and 95% confidence intervals (CIs) for non-Hispanic whites (NHW) as well as non-Hispanic blacks and African Americans (NHB).ResultsOverall, age-adjusted (1 to ≥85 years) homicide was significantly higher in the South (7.6/100,000, 95% CI 7.6-7.7) than the rest of the United States (4.9/100,000, 95% CI 4.8-4.9) even though the southern rate among NHB (18.7/100,000, 95% CI 18.5-18.8) was lower than the rest of the United States (23.3/100,000, 95% CI 23.1-23.5). The overall southern NHB:NHW mortality rate ratio was 5.1 and 10.6 in the rest of the nation. Homicide rates among NHW men were higher in the South than in each of the other US Census areas, whereas corresponding rates among NHB men were lower. For both men and women the NHB:NHW mortality rate ratio was lower in the South than in any other region. In addition, homicide rates among NHB women in the South were equal to or lower than corresponding rates in the West and Midwest. Finally, higher rates for NHW in metropolitan areas led to overall higher NHW mortality rates and relatively low NHB:NHW rates. Southern NHW had a higher percentage of firearms-related homicides (58.4%) than the corresponding percentage in the rest of the United States (49.8%; P < 0.001). Southern NHB used firearms for 78.8% of homicides compared with 83.9% in the rest of the United States (P < 0.001).ConclusionsThe overall high homicide rates in the southern United States were attributable to relatively higher NHW rates than those found in the rest of the country. Further research targeting the role of firearms as well as cultural and other issues could further the understanding of the interrelations of homicide with complex regional and cultural factors.

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