Thanks To The Government, We Finally Have Some Good Numbers About Gun Violence

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Coalition to Stop Gun Violence

Coalition to Stop Gun Violence (Photo credit: Wikipedia)

One of the major issues in dealing with gun violence is that the data seems to fly all over the map.  And if you don’t have reliable data then it’s pretty tough to develop a solid strategy for dealing with the problem. Of course you can always deal with this by saying that there is no problem.  But let’s leave the loonies to talk (or yell) among themselves.  For the rest of us, who believe that we try to make evidence-based decisions, if there ain’t good evidence there ain’t a decision.But this may have changed this week with the release by the American Public Health Association of a report that analyzes firearm injuries from 2003 to 2010, using national data from the Agency for Healthcare Research and Quality, which is a branch of HHS. The study aggregated data from virtually every hospital in the United States, or at least every hospital that is connected to the government through HHS-administered programs like Medicare, Medicaid, Veterans, etc.  In other words, virtually every hospital. And the injury data, drawn from hospital admissions, was coded to pick up just about every type of primary or secondary diagnosis that could have been the result of a gun injury.  The bottom line is this: If this data ain’t complete, there ain’t no complete.

One caveat before I talk about the actual findings:  the data on hospitalizations seriously undercounts the actual level of gun violence because it does not cover ER visits, but only hospital admissions. We can assume that most people who came to the ER with a gunshot wound probably ended up staying in the hospital, but the Department of Justice data on gun violence, which comes from the FBI (which comes from state and local law enforcement) doesn’t break gun injuries out of the much larger category of gun violence, which means any criminal incident in which a gun was involved,whether someone was shot or not.  And of course the hospital data completely undercounts homicides, because even though slightly less than ten percent of hospital admissions resulted in death during the admission period, we can assume that almost all homicides and certainly all suicides were taken not to a hospital or an ER, but to the morgue.

Given the caveats above, the findings of this report still require serious thought and consideration.  First and most important is the fact that of the more than 250,000 gun injuries between 2003 and 2010, more than 30% were classified as self-inflicted wounds.  Of late the NRA has been patting itself on the back because the number of firearm deaths that are ruled as accidents is quite low, so low that accidental gun deaths don’t even make it to the list of major accident deaths published by the CDC.  But gun injuries are very serious, the report gives convincing evidence that the costs of gun injury hospitalizations averages $75,000, which means that we are spending an awful lot of money, nearly one billion dollars every year, on taking care of people who didn’t even know how to handle a gun.

The other significant finding from a public health point of view is that more than one-third of gun injury patients had no medical insurance. But this should not surprise, given the fact that 40% of the hospitalizations involved males between the ages of 18-30, which is exactly the age bracket occupied by people who usually make the conscious decision not to carry medical insurance at all. So not only do we face a serious use of medical resources for gun injuries, a third of which could be prevented by simply locking up, locking away or unloading the guns, but we also face a significant impact on public health budgets, since so many of these patients are uninsured.

It seems to me that enough data has now been produced to move the discussion beyond the debate over whether gun violence represents a health issue at all.  And if anyone reading this blog truly believes that physicians and other health professionals should refrain from talking about guns in terms of health, then they’re reading the wrong blog.  Over the next several weeks I’m going to be making some suggestions about how the medical community might try to deal with gun violence at the level where it really counts – the contact with patients before they become a statistic in the next report.



Gun Violence: Who’s Killing Whom?

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                If we really want to do something about gun violence, it’s time to sit down and have a sober, serious and thoughtful discussion based on facts.  Not based on opinions, not based on political agendas, and not based on rantings and ravings about the 2nd Amendment.  Based on facts.  Here goes:

Fact: 31,000 people died from gunshot wounds last year – 19,000+ suicides, 11,000+ homicides and 800+ accidents.  More children drowned in backyard pools than died from guns.

Fact:  90% of all gun deaths involve a handgun.  The “official” figures tend to over-count long guns because many death and crime reports do not actually describe the type of weapon.

Fact:  50% of gun suicide victims are white males, age 30-50, most legal gun owners.  60% of gun homicide victims are African-American males, age 17 – 30, most shot by other African-American males using illegal guns.

Fact:  If we deduct white male suicides and African-American homicides from the overall gun death rate, the U.S. gun death rate falls from 3.4 per 100,000 to 1.6, well below the gun death rate for such advanced countries as Austria, Belgium, Canada, France, Luxembourg and Israel.  Note that our 1.6/100,000 rate is for a country in which the number of guns circulating amongst civilians exceeds the total of all guns found in the six countries listed above.

The U.S. does seem to be the one advanced country in which shootings involving mass or multiple victims occur on an episodic but not infrequent basis.  And it is these mass slaughters that invariably (but not always) ignites our debate over guns. But the numbers cited above have been published again and again, and the numbers testify to the fact that, with the exception of certain specific groups, we are a law-abiding and basically non-violent country.  Even with 250 million guns floating around.

So what should we do about gun violence?  First, we should tell the truth.  We should stop talking about the assault rifle “threat” on the one hand, and the protections afforded by “armed citizens” on the other.  The nut who walks into a movie theater or a classroom with an AR-15 is in no way typical of the people whose use of guns results in 30,000+ homicides and suicides each year.  For that matter, the guy or gal who takes a two-hour class in gun safety (if a class is even required) is about as ready to defend themselves with a gun as I’m ready to finally go on a real diet.

Telling the truth about gun violence also means telling the truth about the argument over guns.  And the truth is that it’s not really an argument about guns, it’s an argument about the role of government. We long ago decided that government should playa significant role in regulating behavior when the behavior in question impacts the common good.  Try starting an argument about seat belts. Or vaccinations.  Or the design of infant cribs.

The problem with regulating the behavior of gun owners is that there’s no common good because the majority of Americans don’t own guns.  So telling a large, well-organized and extremely vocal minority that they have to suffer more regulations isn’t going to win friends or influence people in the gun world. It’s just going to piss them off.

We know who’s shooting whom with guns.  We need to figure out how to regulate their behavior and the guns they use without worrying about everyone else. I have some ideas that I’ll share with you in blogs to come.

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