Prevalence of State Firearm Mortality and Mental Health Care Resources

A disproportionate share of firearm suicides and homicides are committed by individuals who have a psychiatric diagnosis, many with a history of substance abuse. This study assessed whether selected variables that potentially indicate increased access to mental health care or known demographic risk factors for firearm trauma best predicted state variations in firearm homicide and suicide. Partial correlation coefficients indicated that the proportion of the population within a given state that was African American or Hispanic was significantly associated with increased state firearm homicides. The percent of the population within a given state that had earned a Baccalaureate degree was associated with decreased state firearm homicides. Additionally, increased state firearm ownership rates were significantly associated with firearm suicides, while state educational expenditures were associated with a significant reduction in firearm suicides. The findings suggest that mental health resources within a state have minimal association with firearm homicide and suicide rates. However, state levels of educational achievement and educational expenditures reduce firearm mortality.     

Socioeconomic position in childhood and early adult life and risk of mortality: a prospective study of the mothers of the 1958 British birth cohort

OBJECTIVES: We sought to establish whether women's childhood socioeconomic position influenced their risk of mortality separately from the effects of adult socioeconomic position. METHODS: We examined 11855 British women aged 14 to 49 years, with mortality follow-up over a 45-year period. RESULTS: Trends according to childhood social class were observed for all-cause mortality, circulatory disease, coronary heart disease, respiratory disease, chronic obstructive pulmonary disease, stroke, lung cancer, and stomach cancer, with higher death rates among members of unskilled manual groups. Associations attenuated after adjustment for adult social class, smoking, and body mass index. No trend was seen for breast cancer or accidents and violence. Adverse social conditions in both childhood and adulthood were associated with higher death rates from coronary heart disease and respiratory disease. Stomach cancer was influenced primarily by childhood conditions and lung cancer by factors in adult life. CONCLUSIONS: Socioeconomic position in childhood was associated with adult mortality in a large sample of British women.     

Social inequality and homicide rates in Sao Paulo City, Brazil

OBJECTIVE: The relation between income and mortality due to violence has been studied in recent years. The Synthesis of Social Indicators of 2002 [Sintese de Indicadores Sociais, 2002], published by The Brazilian Institute of Geography and Statistics (IBGE), states that one of the most outstanding characteristic of Brazilian society is inequality. The proposal of this ecological study was to test the association between homicide rates, and some health and socioeconomic indicators. METHODS: This is an ecological cross-sectional study. Data regarding Sao Paulo City, Brazil in the year 2000 was analyzed. The association between homicide coefficients and the following five indicators were tested: infant mortality rates, monthly average income of household heads, percentage of adolescents aged 15 to 17 years not attending school, proportion of pregnant adolescent women aged 14 to 17 years and demographic density. Pearson's correlation coefficient and a multiple linear regression model were utilized to test these associations. RESULTS: The municipal homicide rate was 57.3/100,000. The correlation between homicide rates and average monthly income was strong and negative (r=-0.65). Higher homicide rates were found in the districts whose inhabitants had lower incomes and lower rates were found in those districts whose inhabitants had higher incomes. The correlation between homicide rates and proportion of adolescents not attending school was positive and strong (r=0.68). The correlation between homicide rates and the proportion of pregnant adolescent women was positive and strong (r=0.67). The correlation between homicides and the rate of infant mortality was r=0.24 (for all: p<0.05). The correlation between demographic density and homicides was not significant. Although the univariate regression was positive for four indicators, the multivariate regression test was only significant for average monthly income (negative) and proportion of adolescents not attending school (positive) (for both indicators: p<0.01). CONCLUSIONS: The findings highlight the problem of homicides and socioeconomic disparities in S. Paulo City. Economic development and reducing socioeconomic inequality may have an impact on the rates of mortality due to violence.     

Mortality from external causes in Lithuania: looking for critical points in time and place

AIM: A study was undertaken to analyse trends in mortality from major external causes of death, and to detect urban/rural differences by cut points over the period of socioeconomic transition. METHODS: Information on deaths from major external causes (traffic accidents, suicides, and homicides) for the 1990-2000 period was obtained from Lithuanian Department of Statistics. Mortality rates were age standardized, using the European standard, and analysed, according to (urban/rural) residence and sex. The Jointpoint analysis was used to identify the best-fitting points, wherever a statistically significant change in mortality occurred. RESULTS: The most critical point for external causes of mortality during the period of transition was the year 1994, when an increasing mortality trend reversed to a decreasing one. Mortality from suicides primarily caused these positive changes. Changes in mortality from traffic accidents were not significantly associated with the period under analysis. Numerous less favourable trends in rural areas, including suicide rates, traffic accidents, and homicides, are likely to stratify urban/rural health outcomes in the future. CONCLUSION: Despite a recent decline, mortality from external causes remains at an extremely high level in Lithuania. Future progress requires sustained improvements in prevention, and serious attention to external causes of death in health policy development.     

Motives and Characteristics of Domestic Violence Homicides and Suicides Among Women in India

Domestic violence homicides and suicides are significant causes of deaths among women in India. This study examined characteristics and motives of various types of domestic violence-related homicides and suicides (n = 100) in India using newspaper reports (2011–2012). The majority of victims were found to be young women, mostly killed by burning or strangulation methods. The most frequently reported motive was dowry demands followed by a history of domestic violence or harassment and family conflict. The findings highlight the need for stronger prevention/intervention programs in India to identify and intervene with women at high risk for being killed or committing suicide.     

Surveillance for injuries and violence among older adults.

PROBLEM/CONDITION: Injuries and violence are major causes of disability and death among adults aged > or =65 years in the United States. Injuries impair older adults' quality of life and result in billions of dollars in health-care expenditures each year. REPORTING PERIOD: This report reviews 1987-1996 data regarding fall-related deaths, 1988-1996 data on hospitalizations for hip fracture, 1990-1997 data regarding motor vehicle-related injuries, 1990-1996 data on suicides, and 1987-1996 data on homicides. DESCRIPTION OF SYSTEMS: Data on fall-related deaths, suicides, and homicides are from the National Center for Health Statistics annual mortality data tapes for 1987-1996. Homicide data are supplemented with information from the Federal Bureau of Investigation's Supplemental Homicide Reports for 1987-1996. Data on hospitalizations for hip fracture are from the 1988-1996 National Hospital Discharge Surveys. Information regarding motor vehicle-related injuries for 1990-1997 is from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System and General Estimates System. RESULTS: Rates of fall-related deaths for older adults increased sharply with advancing age and were consistently higher among men in all age categories. Men were 22% more likely than women to sustain fatal falls. A trend of increasing rates of fall-related deaths was observed from 1987 through 1996 in the United States, although rates were consistently lower for women throughout this period. Rates of hospitalizations for hip fracture differed by age and were higher for white women than for other groups. Rates increased with advancing age for both sexes but were consistently higher for women in all age categories. U.S. hospitalization rates for hip fracture increased for women from 1988 through 1996 while the rates for men remained stable. Rates of motor vehicle-related injuries increased slightly from 1990 through 1997, and marked variations in state-specific death rates were observed; in most states, older men had death rates approximately twice those for older women. Although suicide rates remain higher among older adults than among any other age group, rates of suicide among adults aged > or =65 years decreased 16% during the study period. Suicide rates among older adults varied by sex and age group. Homicide rates declined 36% among older adults. Homicide rates were highest for black men, followed by black women and white men; the homicide risk for blacks relative to whites decreased from 4.8 to 3.9 per 100,000 persons, indicating that the gap between rates for blacks and whites is closing. Half of the older homicide victims were killed by someone they knew. INTERPRETATION: The increase in rates of fall-related deaths and hip fracture hospitalizations from 1988 through 1996 might reflect a change in the proportion of adults aged > or =85 years compared with those aged 65-84 years - a change that results, in part, from reduced mortality from cardiovascular and other chronic diseases. Fall-related death rates might be higher among older men because they often have a higher prevalence of comorbid conditions than women of similar age. Racial differences in hospitalization rates might have some underlying biologic basis; the prevalence of osteoporosis, a condition that contributes to reduced bone mass and increased bone fragility, is greatest among older white women. Compared with whites aged > or =65 years, blacks of comparable ages have greater bone mass and are less likely to sustain fall-related hip fractures. Additional studies are needed to determine why rates of motor vehicle-related injury have increased slightly among older adults and why these rates vary by state. Declining rates of suicide among older adults might be related to changes in the effect or type of risk factors traditionally observed in this age group. Research is needed to identify reasons for variations in suicide rates among older persons. Homicides among olde     

Violence-related firearm deaths among residents of metropolitan areas and cities---United States, 2006--2007

Violence-related firearm deaths remain an important public health concern in the United States. During 2006--2007, a total of 25,423 firearm homicides and 34,235 firearm suicides occurred among U.S. residents. These national totals include 4,166 firearm homicides and 1,446 firearm suicides among youths aged 10--19 years; the rate of firearm homicides among youths slightly exceeded the rate among persons of all ages. This report presents statistics on firearm homicides and firearm suicides for major metropolitan areas and cities, with an emphasis on youths aged 10--19 years in recognition of the importance of early prevention efforts. It integrates analyses conducted by CDC in response to requests for detailed information, arising from a heightened focus on urban violence by the media, the public, and policymakers over the past year. Firearm homicides and suicides and annual rates were tabulated for the 50 largest U.S. metropolitan statistical areas (MSAs) and their central cities for 2006--2007, using data from the National Vital Statistics System and the U.S. Census Bureau. Firearm homicide rates in approximately two thirds of the MSAs exceeded the national rate, and 86% of cities had rates higher than those of their MSAs. The youth firearm homicide rate exceeded the all-ages rate in 80% of the MSAs and in 88% of the cities. Firearm suicide rates in just over half of the MSAs were below the national rate, and 55% of cities had rates below those of their MSAs. Youth firearm suicide rates in the MSAs and cities were collectively low compared with all-ages rates. Such variations in firearm homicide and firearm suicide rates, with respect to both urbanization and age, should be considered in the continuing development of prevention programs directed at reducing firearm violence.     

Deaths: preliminary data for 2000.

OBJECTIVES: This report presents preliminary data on deaths for the year 2000 in the United States. U.S. data on deaths are shown by age, sex, race, and Hispanic origin. Data on life expectancy, leading causes of death, and infant mortality are also presented. METHODS: Data in this report are based on a large number of deaths comprising more than 94 percent of the demographic file and 85 percent of the medical file for all deaths in the United States in 2000. The records are weighted to independent control counts of infant deaths, and deaths 1 year and over received in State vital statistics offices for 2000. Unless otherwise indicated, comparisons are made with final data for 1999. For certain causes of death, preliminary data differ from final data because of the truncated nature of the preliminary file. These are, in particular, accidents, homicides, suicides, and respiratory diseases. RESULTS: The age-adjusted death rate in 2000 for the United States decreased slightly from 1999 to a record low in 2000. For causes of death, declines in age-adjusted rates occurred for heart disease, stroke, Chronic liver disease and cirrhosis, diabetes, and cancer. Age-adjusted rates for drug-induced deaths, alcohol-induced deaths, and firearm injuries also decreased during 2000. Declines also occurred for homicides, suicides, unintentional injuries, and Chronic lower respiratory diseases although the extent of the declines cannot be precisely assessed based on the preliminary data. Age-adjusted death rates increased between 1999 and 2000 for the following causes: Pneumonitis from solids and liquids, Alzheimer's disease, kidney disease, hypertension, Influenza and pneumonia, and Septicemia. The infant mortality rate for the black population was 4 percent lower, while the rate for the white population decreased (nonsignificantly) by 2 percent. Life expectancy at birth rose by 0.2 years to a record high of 76.9 years.     

Age-specific patterns of mortality from cardiovascular disease and other major causes, 1969 to 1990

Abstract: There were substantial reductions in mortality rates for all causes of death and for cardiovascular diseases in all age groups examined and both sexes during the period 1969 to 1990. Among young and middle-aged women, cardiovascular diseases were no longer the major cause of death; cancers were. In younger men, accidents, poisonings and violence (including suicides) were the leading cause of death. In middle-aged men, cardiovascular mortality dropped to about the same level as cancer mortality. Only in older people did cardiovascular mortality still dominate. Nevertheless, the proportion of all deaths due to cardiovascular disease remained high and there are opportunities for further reductions. The relative lack of improvement in mortality from cancers suggests that these will form increasing proportions of the burden of disease and treatment costs in the next decades.     

Is male violence directed towards Eve or Mary?

This paper analyses the different categories of violent death and other injuries occurred in Bahia. In Brazil, traffic accidents, homicides and suicides correspond to the third most common cause of death. Besides, violent acts tend to increase the emergency health services demand. The data were collected from the written press covering all the homicides, grave injuries and notified rapes during 1989. Police violence appeared as responsible for the death of a high proportion (24%) of young males, followed by the disagreement between criminals (18.6%). In relation to females, the quantitative dimension of crimes are lower, more diffused and registered in the family environment. The data point to the importance of male domination in the interpretation of those domestic violent acts. Resisting the ideology of women's inferiority means avoiding both injuries and homicides - a complex task for Brazilian society.     

Homicides between men aged 15 to 29 years and related factors in the State of Paraná, Brazil, 2002/2004

Homicides are the main cause of non-natural death in Brazil and studies about them may contribute to their control. The objective of this study was to verify mortality rates due to homicides and legal interventions among young men in the State of Paraná, Brazil, and to identify correlated municipal characteristics. An ecological study was conducted, having the municipalities of the State as units of analysis. Mortality rates of homicides and legal interventions among men from 15 to 29 years of age were calculated for the years 2002-2004 and demographic and social municipal indicators were obtained. Mortality rate in the State was 94.8 per one hundred thousand. The size of the population, the proportion of young people aged 15 to 24 years, the proportion of enrollments in universities and the Gini index were the main indicators correlated to homicide mortality (p<0.0001). Mortality rates were highest in municipalities of metropolitan regions, in those located at the border with Paraguay and in those located in the way between them and the Southeast Region of Brazil. Mortality rates and the proportion of deaths due to firearms increased with the size of the municipality. The greater number of youth and easier access to firearms and illicit drugs in such places may be influencing on these rates.     

Homicides among teenagers in the city of Porto Alegre,Rio Grande do Sul State,Brazil: vulnerability,susceptibility, and gender cultures

The authors present a quantitative and qualitative study on homicides among teenagers in Porto Alegre, Rio Grande do Sul State, Brazil, based on a historical series during the 1990s and the life and death histories in this group, with a special focus on 1997. In that year there were 68 homicides in which the victims were from 10 to 19 years old. Of the 68, 62 were males and only 6 females, or a ratio of 10:1, showing that young males are more vulnerable and susceptible to being murdered. The data indicate that cause of death is influenced by gender culture and that homicides are based on power and status symbols characterizing a kind of virility. This expression of virility in the shaping of violence also appears in the domination of the female body observed in homicides with young women as the victims. The life and death histories of these teenagers highlight the pertinence of the gender-based analysis as a theoretical-analytical category, in addition to analyses considering socioeconomic aspects and social inequity.     

Recent Australian suicide trends for males and females at the national level: has the rate of decline differed?

OBJECTIVES: In keeping with international public health policy development, suicide prevention in Australia has received increasing attention. The mid to late 1990s saw the introduction of a range of co-ordinated national prevention programmes. Since 1997, suicides have decreased, but the comparative rates of decline for males and females have not been well studied at the national level. METHODS: Standardised suicide rates were calculated for males and females, using data from 1997 to 2005. Linear models (ordinary least squares) were used to calculate rates of decline, with trends compared for males and females. RESULTS: Male suicides appear to have fallen more rapidly than female suicides. CONCLUSIONS: Australian males, an 'at risk' demographic, appear to be experiencing benefits from the existence of current national suicide prevention strategies and related social changes. It is recommended that greater consideration be given to researching risk factors such as intimate partner violence, sexual abuse, and substance dependence, for Australian female suicide.     

Violence and fear of violence in East and West Germany

The purpose of this research was to assess the effect of major social changes in Germany since 1989 on mortality due to intentional injury. Mechanisms and types of fatal intentional injury in East and West Germany between 1970 and 1995 were determined from death certificates and compared with judicial data on violent crime convictions and recent public survey data on citizen fear of crime. The number of homicides among East German males increased between 1989 and 1991, and the homicide rate remains high when compared with West German males (although lower than that of American males). Homicide among German females is less common, presently about equally likely in East and West. Violent crime in general has become more frequent in Germany, and citizen fear of crime has increased markedly, especially in the East. Non-citizens are convicted for an increasing number of homicides and assaults. Rates of suicide were declining in East and West before reunification, and these rates have continued to decline. Social changes in Europe since 1989 have led to noticeable increases in violence and homicide in Germany, which in turn have reduced feelings of security among German citizens, especially in the East. Suicide rates have not been affected.     

Factors associated with mortality in a cohort of Australian prisoners

We examined factors associated with increased mortality in a cohort of 85,203 adults with a history of imprisonment in New South Wales, Australia, between 1988 and 2002. Information on death was collected through linkage to the Australian National Death Index. The influence of demographic and criminological factors on the standardised mortality ratio (SMR) for all-cause mortality, and deaths due to drug overdose and suicide was examined using negative binomial regression models. The number of deaths identified was 5,137 (4,714 men, 423 women, 303 in custody). The overall SMR was 3.7 (3.6–3.8) in men and 7.8 (7.1–8.5) in women. SMRs raised for deaths due to drug overdose (men: 12.8, women: 50.3) and suicide (men: 4.8, women: 12.2). The high SMR was associated with hospitalisation for mental illness, multiple imprisonments, and early stage of follow-up independently of causes of death. Being released from prison increased the SMRs for all-cause and drug-related mortality, but not suicide. For women, significant trends for decreasing risk with increasing age were noted. Minority groups, in particular men, had a lower risk of death than white people. In men a sex or drug offence was associated with a lower risk and a property or violence offence was related to higher mortality. Our results reinforce how disadvantaged prisoners are, measured by mortality as the most fundamental scale of human wellbeing. Certain demographic and imprisonment characteristics are indicators of high mortality among this population. The underlying causes of some of these characteristics such as mental illness or multiple imprisonments are potentially treatable and preventable. Prison health services need to develop interventions targeting high-risk groups to avoid this situation.     

Firearm homicide and firearm suicide: opposite but equal

OBJECTIVE: Homicide and suicide are intentional acts of violence that disproportionately involve firearms. Much more effort has been devoted to the ecological study of homicide; methods that have been developed to better understand and subsequently prevent homicide may be applicable to suicide. The purpose of the present study was to compare the occurrence of firearm homicide and firearm suicide using routine activity theory as a framework for analysis. METHODS: Detailed mortality data pertaining to decedents, their neighborhoods, and use of firearms were collected from 1994 to 1998 for the counties containing and surrounding three small to medium-sized U.S. cities. Data from a total of 468 neighborhoods that collectively experienced 1,025 intentional deaths from firearms (396 firearm homicides and 629 firearm suicides) were analyzed. RESULTS: Firearm homicide was consistently associated with out-of-home, nighttime activity in neighborhoods where many people were likely to be coming and going. In an opposite-but-equal fashion, firearm suicide was consistently associated with in-home, daytime activity in out-of-the-way neighborhoods. CONCLUSIONS: Firearm homicide and firearm suicide were found to be consistently associated with markers of routine activity in all three cities, albeit in an opposite-but-equal manner. Because firearm suicides very often occur as lonely events in lonely neighborhoods, they may go under-noticed relative to firearm homicides. More awareness and additional public health studies of firearm suicide, in tandem with firearm homicide, should be pursued to better identify individuals and neighborhoods that are at greatest risk of experiencing each event.     

Increasing mortality among adults in Scotland 1981 to 1999

BACKGROUND: The aim of the study was to describe the change in overall and cause-specific mortality in Scotland between the early 1980s and late 1990s, with particular reference to the mortality experience of young adults. METHOD: The study was based on death records for Scottish residents. Changes in age and cause-specific death rates between 1981-83, 1989-91 and 1997-99 were compared. RESULTS: Between 1981-83 and 1989-91 death rates in Scotland began to rise among young men aged 20-24 while for those aged over 25 rates declined. The greatest fall in rates was experienced at ages 40 to 59. When death rates during 1997-99 were compared to rates in 1989-91 this pattern had changed. During the 1990s death rates among 20 to 34-year-olds increased, with a slight rise at ages 35-44. At older ages overall mortality continued to decline but the greatest fall was at ages 60 and over. Trends among women shared similarities with men. For both men and women falls in mortality from heart disease, stroke, and cancers were being differentially offset by increases in other causes of death across all age groups. The causes of death that contributed to the increased death rate among young adults include to various degrees, suicides, drug deaths, alcohol and violence. CONCLUSION: In Scotland changes in mortality result from a complex combination of different trends in mortality from various causes of death. The rate of decline in mortality among men aged 59 and below is slowing down, and death rates among young men aged 15-44 are increasing. If these trends continue there is a suggestion that future death rates may begin to rise at older ages.     

Deaths: preliminary data for 2004.

OBJECTIVES: This report presents preliminary U.S. data on deaths, death rates, life expectancy, leading causes of death, and infant mortality for the year 2004 by selected characteristics such as age, sex, race, and Hispanic origin. METHODS: Data in this report are based on a large number of deaths comprising approximately 91 percent of the demographic file and 90 percent of the medical file for all deaths in the United States in 2004. The records are weighted to independent control counts for 2004. For certain causes of death such as unintentional injuries, homicides, suicides, and respiratory diseases, preliminary and final data differ because of the truncated nature of the preliminary file. Comparisons are made with 2003 final data. RESULTS: The age-adjusted death rate for the United States decreased from 832.7 deaths per 100,000 population in 2003 to 801.0 deaths per 100,000 population in 2004. Age-adjusted death rates decreased between 2003 and 2004 for the following major causes of death: Diseases of heart, Malignant neoplasms, Cerebrovascular diseases, Chronic lower respiratory diseases, Accidents (unintentional injuries), Diabetes mellitus, Influenza and pneumonia, Septicemia, Chronic liver disease and cirrhosis, and Pneumonitis due to solids and liquids. Rates increased between 2003 and 2004 for the following: Alzheimer's disease and Essential (primary) hypertension and hypertensive renal disease. Life expectancy at birth rose by 0.4 year to a record high of 77.9 years.     

Deaths: preliminary data for 2003.

OBJECTIVES: This report presents preliminary U.S. data on deaths, death rates, life expectancy, leading causes of death, and infant mortality for the year 2003 by selected characteristics such as age, sex, race, and Hispanic origin. METHODS: Data in this report are based on a large number of deaths comprising approximately 93 percent of the demographic file and 91 percent of the medical file for all deaths in the United States in 2003. The records are weighted to independent control counts for 2003. For certain causes of death such as unintentional injuries, homicides, suicides, and respiratory diseases, preliminary, and final data differ because of the truncated nature of the preliminary file. Comparisons are made with 2002 final data. RESULTS: The age-adjusted death rate for the United States decreased from 845.3 deaths per 100,000 population in 2002 to 831.2 deaths per 100,000 population in 2003. Age-adjusted death rates decreased between 2002 and 2003 for the following causes: Diseases of heart, Malignant neoplasms, Cerebrovascular diseases, Accidents (unintentional injuries), Influenza and pneumonia, Intentional self-harm (suicide), Chronic liver disease and cirrhosis, and Pneumonitis due to solids and liquids. They increased between 2002 and 2003 for the following: Alzheimer's disease, Nephritis, nephrotic syndrome and nephrosis, Essential (primary) hypertension and hypertensive renal disease, and Parkinson's disease. Life expectancy at birth rose by 0.3 years to a record high of 77.6 years.