title: Firearm legislation and firearm-related fatalities in the United States.
abstract: OBJECTIVE
  Over 30,000 people die annually in the United States from injuries caused by firearms. Although most firearm laws are enacted by states, whether the laws are associated with rates of firearm deaths is uncertain.
  
  
  OBJECTIVE
  To evaluate whether more firearm laws in a state are associated with fewer firearm fatalities.
  
  
  METHODS
  Using an ecological and cross-sectional method, we retrospectively analyzed all firearm-related deaths reported to the Centers for Disease Control and Prevention Web-based Injury Statistics Query and Reporting System from 2007 through 2010. We used state-level firearm legislation across 5 categories of laws to create a "legislative strength score," and measured the association of the score with state mortality rates using a clustered Poisson regression. States were divided into quartiles based on their score.
  
  
  METHODS
  Fifty US states.
  
  
  METHODS
  Populations of all US states.
  
  
  METHODS
  The outcome measures were state-level firearm-related fatalities per 100,000 individuals per year overall, for suicide, and for homicide. In various models, we controlled for age, sex, race/ethnicity, poverty, unemployment, college education, population density, nonfirearm violence-related deaths, and household firearm ownership.
  
  
  RESULTS
  Over the 4-year study period, there were 121,084 firearm fatalities. The average state-based firearm fatality rates varied from a high of 17.9 (Louisiana) to a low of 2.9 (Hawaii) per 100,000 individuals per year. Annual firearm legislative strength scores ranged from 0 (Utah) to 24 (Massachusetts) of 28 possible points. States in the highest quartile of legislative strength (scores of ≥9) had a lower overall firearm fatality rate than those in the lowest quartile (scores of ≤2) (absolute rate difference, 6.64 deaths/100,000/y; age-adjusted incident rate ratio [IRR], 0.58; 95% CI, 0.37-0.92). Compared with the quartile of states with the fewest laws, the quartile with the most laws had a lower firearm suicide rate (absolute rate difference, 6.25 deaths/100,000/y; IRR, 0.63; 95% CI, 0.48-0.83) and a lower firearm homicide rate (absolute rate difference, 0.40 deaths/100,000/y; IRR, 0.60; 95% CI, 0.38-0.95).
  
  
  CONCLUSIONS
  A higher number of firearm laws in a state are associated with a lower rate of firearm fatalities in the state, overall and for suicides and homicides individually. As our study could not determine cause-and-effect relationships, further studies are necessary to define the nature of this association.
authors: Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA. Eric.Fleegler@childrens.harvard.edu
authors: Eric W
authors: EW
authors: Fleegler
authors: Lois K
authors: LK
authors: Lee
authors: Michael C
authors: MC
authors: Monuteaux
authors: David
authors: D
authors: Hemenway
authors: Rebekah
authors: R
authors: Mannix
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002487:Centers for Disease Control and Prevention, U.S.; D015986:Confounding Factors, Epidemiologic; D003430:Cross-Sectional Studies; D005260:Female; D005389:Firearms / Q000331:legislation & jurisprudence*; D006254:Hawaii / Q000453:epidemiology; D006708:Homicide / Q000706:statistics & numerical data*; D006801:Humans; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D016017:Odds Ratio; D016012:Poisson Distribution; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013405:Suicide / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014589:Utah