017 - Firearm Violence in Arizona: Data to Support Policy and Advocacy

Background: Reports of firearm violence have become a daily fixture of the news cycle in the United States. Between 1981 and 2020, 1,357,504 Americans and 33,838 Arizonans were killed by firearms. Many more had non-fatal injuries. Firearm deaths now exceed motor vehicle deaths in both AZ and the US. About one-third of US adults report owning a firearm, while 42% reside in a household with firearms. In addition to the human toll, firearm violence carries a significant economic toll, both through medical costs and years of potential life lost, estimated at $557 billion nationally and $16 billion in AZ in 2019. Despite public support for reasonable and effective gun control laws, few preventative actions have been taken nationally or in most states to curb this uniquely American tragedy. AZ's very weak gun control laws have warranted a "failing" rating from multiple independent research organizations, clearly indicating the need for further legislation. Firearm violence in AZ takes many forms and varies depending on race, ethnicity, sex, and rurality, among other factors. This report was prepared for the Arizona Public Health Association to support policy and advocacy priorities.

Methods: This report was compiled using publicly accessible data sources including the CDC Multiple Cause of Death database (WONDER), the CDC Web-based Injury Statistics Query and Reporting System (WISQARS), and the CDC National Violent Death Reporting System. Several other non-governmental publicly available data sources were also utilized to characterize gun ownership, the strength of state gun safety laws, school shootings, police shootings, and other data. Annual trends were analyzed using Joinpoint software from the National Cancer Institute and a literature review was conducted to incorporate findings from analytic epidemiologic research and to identify policies in other states as possible models for AZ.

Results: Preliminary analysis revealed that AZ is performing worse than the national average on virtually all indicators of gun mortality. From 1999-2020, the age-adjusted firearm mortality rate per 100,000 among Arizonans was 42% higher than the national rate. Joinpoint trend analysis indicated that firearm deaths in AZ peaked in 1995, then declined until 2014 when rates began increasing by 3% per year. The leading cause of firearm death in AZ is suicide (65%), followed by homicide (31%). While firearm suicide rates have been slowly increasing (0.6% per year), firearm homicide rates declined sharply (7% per year) between 2005 and 2014, then increased by the same rate after 2014. Firearm deaths resulted in 28,049 YPLL before age 65 in 2020, over half of which were due to suicide. Stratification by several demographic indicators revealed statistically significant disparities in firearm mortality in AZ. From 1999-2020, the risk of firearm mortality among non-metro residents was 12% higher than the risk among metro residents. The firearm mortality rate among males was nearly 6-fold higher than among females. Analysis of racial and ethnic disparities showed that the risk of firearm mortality among non-Hispanic Black people was 35% higher than for non-Hispanic White people in AZ. Rates among Hispanics were 84% higher in AZ than in the US. Firearm mortality rate were two-fold higher in states with the weakest guns laws compared to states with the strongest gun laws.

Discussion: Initial data analysis highlights disparities that may be amenable to local legislative action. Discussed in light of the June 2022 Supreme Court ruling which stipulated a constitutional right to concealed carry and the passage of the federal Bipartisan Safer Communities Act, this report presents findings through the public health model of gun violence prevention. This framework is used to define the problem of gun violence in AZ, identify risk factors, and propose prevention strategies to promote a safer community for all Arizonans.

Firearm mortality

Gun violence

Socioeconomic disparities

Public health policy

Firearm injury

Injury prevention