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Analysis of Firearm Violence During the COVID-19 Pandemic in the US

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  How did interpersonal firearm violence change temporally and spatially in the first year of the COVID-19 pandemic period in the US?

Findings  In this nationwide cross-sectional study of the US, the pandemic period was associated with a 15.0% increase in firearm-related incidents, a 34.3% increase in firearm-related nonfatal injuries, and a 28.4% increase in firearm-related deaths. The excess burden was more pronounced from June to October 2020 and in Minnesota and New York State.

Meaning  These findings suggest that the COVID-19 pandemic was associated with an excess burden of firearm violence, with substantial temporal and spatial variations.


Importance  In the US, the COVID-19 pandemic intensified some conditions that may contribute to firearm violence, and a recent surge in firearm sales during the pandemic has been reported. However, patterns of change in firearm violence in the first year of the COVID-19 pandemic in the US remain unclear.

Objective  To quantify the changes in interpersonal firearm violence associated with the pandemic across all 50 US states and the District of Columbia.

Design, Setting, and Participants  This population-based cross-sectional study examined 50 US states and the District of Columbia from January 1, 2016, to February 28, 2021. The COVID-19 pandemic period was defined as between March 1, 2020, and February 28, 2021. Statistical analysis was performed from April to December 2021.

Main Outcomes and Measures  A 2-stage interrupted time-series design was used to examine the excess burden of firearm-related incidents, nonfatal injuries, and deaths associated with the pandemic while accounting for long-term trends and seasonality. In the first stage, separate quasi-Poisson regression models were fit to the daily number of firearm events in each state. In the second stage, estimates were pooled using a multivariate meta-analysis.

Results  In the US (all 50 states and the District of Columbia) during the pandemic period of March 1, 2020, to February 28, 2021, there were 62 485 identified firearm-related incidents, 40 021 firearm-related nonfatal injuries, and 19 818 firearm-related deaths. The pandemic period was associated with 8138 (95% empirical confidence interval [eCI], 2769-12 948) excess incidents (increase of 15.0% [95% eCI, 4.6%-26.1%]), 10 222 (95% eCI, 8284-11 650) excess nonfatal injuries (increase of 34.3% [95% eCI, 26.1%-41.1%]), and 4381 (95% eCI, 2262-6264) excess deaths (increase of 28.4% [95% eCI, 12.9%-46.2%]). The increase in firearm-related violence was more pronounced from June to October 2020 and in Minnesota and New York State.

Conclusions and Relevance  In the US, the first year of the COVID-19 pandemic was associated with an excess burden of firearm-related incidents, nonfatal injuries, and deaths, with substantial temporal and spatial variations.

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Article Information

Accepted for Publication: March 10, 2022.

Published: April 28, 2022. doi:10.1001/jamanetworkopen.2022.9393

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Sun S et al. JAMA Network Open.

Corresponding Author: Shengzhi Sun, PhD, School of Public Health, Capital Medical University, Beijing 100069, China (szsun@bu.edu).

Author Contributions: Dr Sun had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Sun, Cao, and Ge contributed equally to this work.

Concept and design: Sun, Cao, Ge, Wellenius.

Acquisition, analysis, or interpretation of data: Sun, Ge, Siegel, Wellenius.

Drafting of the manuscript: Sun, Cao, Ge.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Sun, Cao, Ge, Wellenius.

Administrative, technical, or material support: Siegel.

Supervision: Siegel, Wellenius.

Conflict of Interest Disclosures: Dr Wellenius reported serving as a consultant to the Health Effects Institute and Google LLC. No other disclosures were reported.

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