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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.

Abstract

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.

References
1.
CDC. United States COVID-19 Cases and Deaths by State. Accessed April 12, 2021. https://covid.cdc.gov/covid-data-tracker/#cases_totalcases
2.
Bayham  J , Fenichel  EP .  Impact of school closures for COVID-19 on the US health-care workforce and net mortality: a modelling study.   Lancet Public Health. 2020;5(5):e271-e278. doi:10.1016/S2468-2667(20)30082-7PubMedGoogle ScholarCrossref
3.
Clemens  V , Deschamps  P , Fegert  JM ,  et al.  Potential effects of “social” distancing measures and school lockdown on child and adolescent mental health.   Eur Child Adolesc Psychiatry. 2020;29(6):739-742. doi:10.1007/s00787-020-01549-wPubMedGoogle ScholarCrossref
4.
Tanaka  T , Okamoto  S .  Increase in suicide following an initial decline during the COVID-19 pandemic in Japan.   Nat Hum Behav. 2021;5(2):229-238. doi:10.1038/s41562-020-01042-zPubMedGoogle ScholarCrossref
5.
Newlove-Delgado  T , McManus  S , Sadler  K ,  et al; Mental Health of Children and Young People group.  Child mental health in England before and during the COVID-19 lockdown.   Lancet Psychiatry. 2021;8(5):353-354. doi:10.1016/S2215-0366(20)30570-8PubMedGoogle ScholarCrossref
6.
Carr  MJ , Steeg  S , Webb  RT ,  et al.  Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort study.   Lancet Public Health. 2021;6(2):e124-e135. doi:10.1016/S2468-2667(20)30288-7PubMedGoogle ScholarCrossref
7.
Kravitz-Wirtz  N , Aubel  A , Schleimer  J , Pallin  R , Wintemute  G .  Public concern about violence, firearms, and the COVID-19 pandemic in California.   JAMA Netw Open. 2021;4(1):e2033484-e2033484. doi:10.1001/jamanetworkopen.2020.33484PubMedGoogle ScholarCrossref
8.
Grinshteyn  E , Hemenway  D .  Violent death rates in the US compared to those of the other high-income countries, 2015.   Prev Med. 2019;123:20-26. doi:10.1016/j.ypmed.2019.02.026PubMedGoogle ScholarCrossref
9.
Donnelly  MR , Grigorian  A , Inaba  K ,  et al.  A dual pandemic: the influence of coronavirus disease 2019 on trends and types of firearm violence in California, Ohio, and the United States.   J Surg Res. 2021;263:24-33. doi:10.1016/j.jss.2021.01.018PubMedGoogle ScholarCrossref
10.
Ashby  MPJ .  Initial evidence on the relationship between the coronavirus pandemic and crime in the United States.   Crime Sci. 2020;9(1):6. doi:10.1186/s40163-020-00117-6PubMedGoogle ScholarCrossref
11.
Boserup  B , McKenney  M , Elkbuli  A .  Alarming trends in US domestic violence during the COVID-19 pandemic.   Am J Emerg Med. 2020;38(12):2753-2755. doi:10.1016/j.ajem.2020.04.077PubMedGoogle ScholarCrossref
12.
Sutherland  M , McKenney  M , Elkbuli  A .  Gun violence during COVID-19 pandemic: paradoxical trends in New York City, Chicago, Los Angeles and Baltimore.   Am J Emerg Med. 2021;39:225-226. doi:10.1016/j.ajem.2020.05.006PubMedGoogle ScholarCrossref
13.
Kim  D-Y , Phillips  SW .  When COVID-19 and guns meet: a rise in shootings.   J Crim Justice. 2021;73:101783. doi:10.1016/j.jcrimjus.2021.101783PubMedGoogle ScholarCrossref
14.
Abrams  DS .  COVID and crime: an early empirical look.   J Public Econ. 2021;194:104344. doi:10.1016/j.jpubeco.2020.104344PubMedGoogle ScholarCrossref
15.
Bullinger  LR , Carr  JB , Packham  A .  COVID-19 and crime: effects of stay-at-home orders on domestic violence.   Am J Health Econ. 2021;7(3):249-280. doi:10.1086/713787Google ScholarCrossref
16.
Beard  JH , Jacoby  SF , Maher  Z ,  et al.  Changes in shooting incidence in Philadelphia, Pennsylvania, between March and November 2020.   JAMA. 2021;325(13):1327-1328. doi:10.1001/jama.2021.1534PubMedGoogle ScholarCrossref
17.
Schleimer  JP , McCort  CD , Shev  AB ,  et al.  Firearm purchasing and firearm violence during the coronavirus pandemic in the United States: a cross-sectional study.   Inj Epidemiol. 2021;8(1):43. doi:10.1186/s40621-021-00339-5PubMedGoogle ScholarCrossref
18.
Pino  EC , Gebo  E , Dugan  E , Jay  J .  Trends in violent penetrating injuries during the first year of the COVID-19 pandemic.   JAMA Netw Open. 2022;5(2):e2145708-e2145708. doi:10.1001/jamanetworkopen.2021.45708PubMedGoogle ScholarCrossref
19.
Gun Violence Archive. Gun Violence Archive 2016-2021. Accessed March 20, 2021. https://www.gunviolencearchive.org/
20.
Gun Violence Archive. General methodology. Accessed May 10, 2021. https://www.gunviolencearchive.org/methodology
21.
Kim  D .  Social determinants of health in relation to firearm-related homicides in the United States: a nationwide multilevel cross-sectional study.   PLoS Med. 2019;16(12):e1002978. doi:10.1371/journal.pmed.1002978PubMedGoogle ScholarCrossref
22.
Conner  A , Azrael  D , Lyons  VH , Barber  C , Miller  M .  Validating the national violent death reporting system as a source of data on fatal shootings of civilians by law enforcement officers.   Am J Public Health. 2019;109(4):578-584. doi:10.2105/AJPH.2018.304904PubMedGoogle ScholarCrossref
23.
Booty  M , O’Dwyer  J , Webster  D , McCourt  A , Crifasi  C .  Describing a “mass shooting”: the role of databases in understanding burden.   Inj Epidemiol. 2019;6(1):47. doi:10.1186/s40621-019-0226-7PubMedGoogle ScholarCrossref
24.
Scortichini  M , Schneider Dos Santos  R , De’ Donato  F ,  et al.  Excess mortality during the COVID-19 outbreak in Italy: a two-stage interrupted time-series analysis.   Int J Epidemiol. 2021;49(6):1909-1917. doi:10.1093/ije/dyaa169PubMedGoogle ScholarCrossref
25.
Gasparrini  A .  Modeling exposure-lag-response associations with distributed lag non-linear models.   Stat Med. 2014;33(5):881-899. doi:10.1002/sim.5963PubMedGoogle ScholarCrossref
26.
Gasparrini  A , Armstrong  B , Kenward  MG .  Multivariate meta-analysis for non-linear and other multi-parameter associations.   Stat Med. 2012;31(29):3821-3839. doi:10.1002/sim.5471PubMedGoogle ScholarCrossref
27.
Gasparrini  A , Leone  M .  Attributable risk from distributed lag models.   BMC Med Res Methodol. 2014;14(1):55. doi:10.1186/1471-2288-14-55PubMedGoogle ScholarCrossref
28.
OpenDataPhilly. Shooting victims. 2021. Accessed July 24, 2021. https://www.opendataphilly.org/dataset/shooting-victims
29.
National Center for Injury Prevention and Control. CDC WISQARS injury mortality report. Accessed March 9, 2022. https://wisqars.cdc.gov/fatal-reports
30.
Bilinski  A , Emanuel  EJ .  COVID-19 and excess all-cause mortality in the US and 18 comparison countries.   JAMA. 2020;324(20):2100-2102. doi:10.1001/jama.2020.20717PubMedGoogle ScholarCrossref
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