Social determinants of health in relation to firearm-related homicides in the United States: A nationwide multilevel cross-sectional study

English version

Autoři: Daniel Kim ^aff001
Působiště autorů: Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, United States of America ^aff001
Vyšlo v časopise: Social determinants of health in relation to firearm-related homicides in the United States: A nationwide multilevel cross-sectional study. PLoS Med 16(12): e32767. doi:10.1371/journal.pmed.1002978
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pmed.1002978

Souhrn

Background

Gun violence has shortened the average life expectancy of Americans, and better knowledge about the root causes of gun violence is crucial to its prevention. While some empirical evidence exists regarding the impacts of social and economic factors on violence and firearm homicide rates, to the author’s knowledge, there has yet to be a comprehensive and comparative lagged, multilevel investigation of major social determinants of health in relation to firearm homicides and mass shootings.

Methods and findings

This study used negative binomial regression models and geolocated gun homicide incident data from January 1, 2015, to December 31, 2015, to explore and compare the independent associations of key state-, county-, and neighborhood-level social determinants of health—social mobility, social capital, income inequality, racial and economic segregation, and social spending—with neighborhood firearm-related homicides and mass shootings in the United States, accounting for relevant state firearm laws and a variety of state, county, and neighborhood (census tract [CT]) characteristics. Latitude and longitude coordinates on firearm-related deaths were previously collected by the Gun Violence Archive, and then linked by the British newspaper The Guardian to CTs according to 2010 Census geographies. The study population consisted of all 74,134 CTs as defined for the 2010 Census in the 48 states of the contiguous US. The final sample spanned 70,579 CTs, containing an estimated 314,247,908 individuals, or 98% of the total US population in 2015. The analyses were based on 13,060 firearm-related deaths in 2015, with 11,244 non-mass shootings taking place in 8,673 CTs and 141 mass shootings occurring in 138 CTs. For area-level social determinants, lag periods of 3 to 17 years were examined based on existing theory, empirical evidence, and data availability. County-level institutional social capital (levels of trust in institutions), social mobility, income inequality, and public welfare spending exhibited robust relationships with CT-level gun homicide rates and the total numbers of combined non-mass and mass shooting homicide incidents and non-mass shooting homicide incidents alone. A 1–standard deviation (SD) increase in institutional social capital was linked to a 19% reduction in the homicide rate (incidence rate ratio [IRR] = 0.81, 95% CI 0.73–0.91, p < 0.001) and a 17% decrease in the number of firearm homicide incidents (IRR = 0.83, 95% CI 0.73–0.95, p = 0.01). Upward social mobility was related to a 25% reduction in the gun homicide rate (IRR = 0.75, 95% CI 0.66–0.86, p < 0.001) and a 24% decrease in the number of homicide incidents (IRR = 0.76, 95% CI 0.67–0.87, p < 0.001). Meanwhile, 1-SD increases in the neighborhood percentages of residents in poverty and males living alone were associated with 26%–27% and 12% higher homicide rates, respectively. Study limitations include possible residual confounding by factors at the individual/household level, and lack of disaggregation of gun homicide data by gender and race/ethnicity.

Conclusions

This study finds that the rich–poor gap, level of citizens’ trust in institutions, economic opportunity, and public welfare spending are all related to firearm homicide rates in the US. Further establishing the causal nature of these associations and modifying these social determinants may help to address the growing gun violence epidemic and reverse recent life expectancy declines among Americans.

Klíčová slova:

Behavioral and social aspects of health – Census – Firearms – Homicide – Social welfare – Socioeconomic aspects of health – United States – Social mobility

Zdroje

1. Beauchamp Z. Guns killed more Americans in 12 years than AIDS, war, and illegal drug overdoses combined. Vox. 2016 Jun 12 [cited 2019 Jun 1]. https://www.vox.com/2015/10/3/9446193/gun-deaths-aids-war-terrorism.

2. CDC WONDER. Underlying cause of death, 1999–2017 request. Atlanta: Centers for Disease Control and Prevention; 2019 [cited 2019 Nov 13]. https://wonder.cdc.gov/controller/datarequest/D76.

3. Fowler KA, Dahlberg LL, Haileyesus T, Annest JL. Firearm injuries in the United States. Prev Med. 2015;(79):5–14.

4. Kalesan B, Mobily ME, Keiser O, Fagan JA, Galea S. Firearm legislation and firearm mortality in the USA: a cross-sectional, state-level study. Lancet. 2016;387(10030):1847–55. doi: 10.1016/S0140-6736(15)01026-0 26972843

5. Siegel M, Xuan Z, Ross CS, Galea S, Kalesan B, Fleegler E, et al. Easiness of legal access to concealed firearm permits and homicide rates in the United States. Am J Public Health. 2017;107:1923–9. doi: 10.2105/AJPH.2017.304057 29048964

6. Santaella-Tenorio J, Cerdá M, Villaveces A, Galea S. What do we know about the association between firearm legislation and firearm-related injuries?. Epidemiol Rev. 2016;38(1):140–57. doi: 10.1093/epirev/mxv012 26905895

7. Rivara FP, Studdert DM, Wintemute GJ. Firearm-related mortality: a global public health problem. JAMA. 2018;320(8):764–5. doi: 10.1001/jama.2018.9942 30167677

8. Davis AB, Gaudino JA, Soskolne CL, Al-Delaimy WK, International Network for Epidemiology in Policy. The role of epidemiology in firearm violence prevention: a Policy Brief. Int J Epidemiol. 2018;47(4):1015–9. doi: 10.1093/ije/dyy059 29718257

9. Hemenway D. Reducing firearm violence. Crime Justice. 2017;46:201–30.

10. Marmot M, Friel S, Bell R, Houweling TA, Taylor S, Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372(9650):1661–9. doi: 10.1016/S0140-6736(08)61690-6 18994664

11. Chetty R, Hendren N, Kline P, Saez E. Where is the land of opportunity? The geography of intergenerational mobility in the United States. Q J Econ. 2014;129:1553–623.

12. Venkataramani AS, Brigell R, O’Brien R, Chatterjee P, Kawachi I, Tsai AC. Economic opportunity, health behaviors, and health outcomes in the USA: a population-based cross-sectional study. Lancet Public Health. 2016;1(1):e18–25. doi: 10.1016/S2468-2667(16)30005-6 29253376

13. Garcia RM, Taylor RB, Lawton BA. Impacts of violent crime and neighborhood structure on trusting your neighbors. Justice Q. 2007;24(4):679–704.

14. Gun Violence Archive. Mass shootings—2015. Washington (DC): Gun Violence Archive; 2019 [cited 2019 Jun 1]. https://www.gunviolencearchive.org/reports/mass-shootings/2015.

15. Aufrichtig A. Mapping US gun murders at a micro level: new data zooms in on violence. The Guardian. 2017 Mar 20 [cited 2019 Jun 1]. https://www.theguardian.com/world/2017/mar/20/mapping-gun-murders-micro-level-new-data-2015?CMP.

16. GovTrack. H.R. 2076 (112th): Investigative Assistance for Violent Crimes Act of 2012. GovTrack; 2013 Jan 2 [cited 2019 Jun 1]. https://www.govtrack.us/congress/bills/112/hr2076/text

17. Kim D, Griffin BA, Kabeto M, Escarce J, Langa KM, Shih RA. Lagged associations of metropolitan statistical area-and state-level income inequality with cognitive function: the Health and Retirement Study. PLoS ONE. 2016;11(6):e0157327. doi: 10.1371/journal.pone.0157327 27332986

18. Blakely TA, Kennedy BP, Glass R, Kawachi I. What is the lag time between income inequality and health status? J Epidemiol Community Health. 2000;54(4):318–9. doi: 10.1136/jech.54.4.318 10827916

19. United States Census Bureau. American Community Survey. Suitland (MD): United States Census Bureau; 2019 [cited 2019 Nov 13]. https://factfinder.census.gov/faces/nav/jsf/pages/programs.xhtml?program=acs.

20. Internal Revenue Service. Statistics of income: individual income tax returns, 2012. Technical report. Washington (DC): Internal Revenue Service; 2013.

21. Kim D. The associations between US state and local social spending, income inequality, and individual all-cause and cause-specific mortality: the National Longitudinal Mortality Study. Prev Med. 2016;84:62–8. doi: 10.1016/j.ypmed.2015.11.013 26607868

22. Rowhani-Rahbar A, Quistberg DA, Morgan ER, Hajat A, Rivara FP. Income inequality and firearm homicide in the US: a county-level cohort study. Inj Prev. 2019;25(Suppl 1):i25–30. doi: 10.1136/injuryprev-2018-043080 30782593

23. Mellor JM, Milyo J. Is exposure to income inequality a public health concern? Lagged effects of income inequality on individual and population health. Health Serv Res. 2003;38:137–51. doi: 10.1111/1475-6773.00109 12650385

24. Vice Chairman’s Staff of the Joint Economic Committee. The geography of social capital in America. St. George (UT): Office of Senator Michael S. Lee; 2018 Apr 11 [cited 2019 Jun 1]. https://www.lee.senate.gov/public/index.cfm?a=files.serve&File_id=DA64FDB7-3B2E-40D4-B9E3-07001B81EC31.

25. United States Census Bureau. Current Population Survey (CPS): supplemental surveys. Suitland (MD): United States Census Bureau; 2018 Apr 30 [cited 2019 Jun 1]. http://www.census.gov/programs-surveys/cps/about/supplemental-surveys.html.

26. National Center for Charitable Statistics. Guide to using NCCS data. National Center for Charitable Statistics; 2018 Dec 13 [cited 2019 Jun 1]. http://nccs-data.urban.org/NCCS-data-guide.pdf.

27. US Election Assistance Commission. 2012 Election administration and voting survey: a summary of key findings, September 2013. Silver Spring (MD): US Election Assistance Commission; 2013 Sept [cited 2019 Jun 1]. https://www.eac.gov/assets/1/6/2012ElectionAdministrationandVoterSurvey.pdf.

28. US Election Assistance Commission. The election administration and voting survey: 2016 comprehensive report. Silver Spring (MD): US Election Assistance Commission; 2016 [cited 2019 Jun 1]. https://www.eac.gov/assets/1/6/2016_EAVS_Comprehensive_Report.pdf.

29. United States Census Bureau. Annual survey of state & local government finances. Suitland (MD): United States Census Bureau; 2019 [cited 2019 Jun 1]. http://www.census.gov/econ/overview/go0400.html.

30. Sipsma HL, Canavan ME, Rogan E, Taylor LA, Talbert-Slagle KM, Bradley EH. Spending on social and public health services and its association with homicide in the USA: an ecological study. BMJ Open. 2017;7(10):e016379. doi: 10.1136/bmjopen-2017-016379 29025831

31. Phillips JA. Explaining discrepant findings in cross-sectional and longitudinal analyses: an application to US homicide rates. Soc Sci Res. 2006;35(4):948–74.

32. Graif C, Sampson RJ. Spatial heterogeneity in the effects of immigration and diversity on neighborhood homicide rates. Homicide Stud. 2009;13(3):242–60. doi: 10.1177/1088767909336728 20671811

33. Votruba ME, Kling JR. Effects of neighborhood characteristics on the mortality of black male youth: evidence from Gautreaux, Chicago. Soc Sci Med. 2009;68(5):814–23. doi: 10.1016/j.socscimed.2008.12.018 19155115

34. Jenson J, Saint-Martin D. New routes to social cohesion? Citizenship and the social investment state. Can J Sociol. 2003;1:77–99.

35. Krueger AB. The rise and consequences of inequality in the United States. Washington (DC): Obama White House Archives; 2012 Jan 12 [cited 2019 Jun 1]. https://obamawhitehouse.archives.gov/sites/default/files/krueger_cap_speech_final_remarks.pdf.

36. Kumlin S, Rothstein B. Making and breaking social capital: the impact of welfare state institutions. Comp Polit Stud. 2005;38(4):339–65.

37. Kääriäinen J, Lehtonen H. The variety of social capital in welfare state regimes—a comparative study of 21 countries. European Societies. 2006;8(1):27–57.

38. Iceland J. Beyond black and white: metropolitan residential segregation in multiethnic America. Soc Sci Res. 2004;33(2):248–71.

39. Reardon SF, Firebaugh G. Measures of multigroup segregation. Sociol Methodol. 2002;32(1):33–67.

40. Fleegler EW, Lee LK, Monuteaux MC, Hemenway D, Mannix R. Firearm legislation and firearm-related fatalities in the United States. JAMA Intern Med. 2013;173(9):732–40. doi: 10.1001/jamainternmed.2013.1286 23467753

41. Armstead TL, Wilkins N, Nation M. Structural and social determinants of inequities in violence risk: a review of indicators. J Community Psychol. 2019 Aug 17. doi: 10.1002/jcop.22232 31421656

42. Branas CC, Richmond TS, Schwab CW. Firearm homicide and firearm suicide: opposite but equal. Public Health Rep. 2004;119(2):114–24. doi: 10.1177/003335490411900203 15192897

43. Pratt TC, Cullen FT. Assessing macro-level predictors and theories of crime: a meta-analysis. Crime Justice. 2005;32:373–450.

44. Inter-university Consortium for Political and Social Research. County characteristics, 2000–2007. Ann Arbor (MI): Inter-university Consortium for Political and Social Research; 2008.

45. UCLA Institute for Digital Research and Education. Zero-inflated negative binomial regression: SAS data analysis examples. Los Angeles: UCLA Institute for Digital Research and Education; 2019 [cited 2019 Jun 1]. https://stats.idre.ucla.edu/sas/dae/zero-inflated-negative-binomial-regression.

46. Vuong Q. Likelihood ratio tests for model selection and non-nested hypotheses. Econometrica. 1989;57:307–34.

47. Clarke KA. A simple distribution-free test for non-nested model selection. Polit Anal. 2007;15(3):347–63.

48. Pan W. Akaike’s information criterion in generalized estimating equations. Biometrics. 2001;57(1):120–5. doi: 10.1111/j.0006-341x.2001.00120.x 11252586

49. Ringle CM, Wende S, Becker JM. SmartPLS 3. Boenningstedt: SmartPLS; 2015.

50. Baron RM, Kenny DA. The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Personality Soc Psychol. 1986;51(6):1173.

51. Valeri L, VanderWeele TJ. Mediation analysis allowing for exposure–mediator interactions and causal interpretation: theoretical assumptions and implementation with SAS and SPSS macros. Psychol Methods. 2013;18(2):137. doi: 10.1037/a0031034 23379553

52. Krouse WJ, Richardson DJ. Mass murder with firearms: incidents and victims, 1999–2013. R44126. Washington (DC): Congressional Research Service; 2015.

53. Cameron AC, Miller DL. A practitioner’s guide to cluster-robust inference. J Hum Resour. 2015;50(2):317–72.

54. Kim D, Subramanian SV, Kawachi I. Social capital and physical health: a systematic review of the literature. In: Kawachi I, Subramanian S, Kim D, editors. Social capital and health. New York: Springer; 2008. pp. 139–90.

55. Gilbert KL, Quinn SC, Goodman RM, Butler J, Wallace J. A meta-analysis of social capital and health: a case for needed research. J Health Psychol. 2013;18(11):1385–99. doi: 10.1177/1359105311435983 23548810

56. Sampson RJ, Raudenbush SW, Earls F. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science. 1997;277(5328):918–24. doi: 10.1126/science.277.5328.918 9252316

57. Rosenfeld R. Documenting and explaining the 2015 homicide rise: research directions. Washington (DC): National Institute of Justice; 2016 Jun [cited 2019 Jun 1]. https://www.ncjrs.gov/pdffiles1/nij/249895.pdf.

58. Roth R. American homicide. Cambridge (MA): Harvard University Press; 2012.

59. Tyler Tom. R. Why people obey the law. Princeton (NJ): Princeton University Press; 2006.

60. Kondo N, Sembajwe G, Kawachi I, van Dam RM, Subramanian SV, Yamagata Z. Income inequality, mortality, and self rated health: meta-analysis of multilevel studies. BMJ. 2009;339:b4471. doi: 10.1136/bmj.b4471 19903981

61. Roberts A, Willits D. Income inequality and homicide in the United States: consistency across different income inequality measures and disaggregated homicide types. Homicide Stud. 2015;19(1):28–57.

62. Kramer MR, Hogue CR. Is segregation bad for your health? Epidemiol Rev. 2009;31(1):178–94.

63. Mehra R, Boyd LM, Ickovics JR. Racial residential segregation and adverse birth outcomes: a systematic review and meta-analysis. Soc Sci Med. 2017;191:237–50. doi: 10.1016/j.socscimed.2017.09.018 28942206

64. Venkataramani AS, Chatterjee P, Kawachi I, Tsai AC. Economic opportunity, health behaviors, and mortality in the United States. Am J Public Health. 2016;106(3):478–84. doi: 10.2105/AJPH.2015.302941 26691108

65. Grossman M. On the concept of health capital and the demand for health. J Polit Econ. 1972;80:223–55.

66. Snyder CR, Irving LM, Anderson JR. Hope and health. In: Snyder CR, Forsyth DR, editors. Handbook of social and clinical psychology: the health perspective. Elmsford (NY): Pergamon Press; 1991.

67. Dabla-Norris ME, Kochhar MK, Suphaphiphat MN, Ricka MF, Tsounta E. Causes and consequences of income inequality: a global perspective. Washington (DC): International Monetary Fund; 2015 [cited 2019 Nov 13]. https://www.imf.org/external/pubs/ft/sdn/2015/sdn1513.pdf.

68. Rosenfeld R, Baumer E, Messner SF. Social trust, firearm prevalence, and homicide. Ann Epidemiol. 2007;17(2):119–25. doi: 10.1016/j.annepidem.2006.07.016 17178232

69. Kennedy BP, Kawachi I, Prothrow-Stith D, Lochner K, Gupta V. Social capital, income inequality, and firearm violent crime. Soc Sci Med. 1998;47(1):7–17. doi: 10.1016/s0277-9536(98)00097-5 9683374

70. Rosenfeld R, Messner SF, Baumer EP. Social capital and homicide. Soc Forces. 2001;80(1):283–310.

71. De Coster S, Heimer K, Wittrock SM. Neighborhood disadvantage, social capital, street context, and youth violence. Sociol Q. 2006;47(4):723–53.

72. Deller SC, Deller MA. Rural crime and social capital. Growth Change. 2010;41(2):221–75.

73. Roth R. How the erosion of trust leads to murders and mass shootings. The Washington Post. 2017 Oct 6 [cited 2019 Jun 1]. https://www.washingtonpost.com/outlook/how-the-erosion-of-trust-leads-to-murders-and-mass-shootings/2017/10/06/382cc4b2-a91e-11e7-92d1-58c702d2d975_story.html.

74. McCall PL, Land KC, Parker KF. Heterogeneity in the rise and decline of city-level homicide rates, 1976–2005: a latent trajectory analysis. Soc Sci Res. 2011;40(1):363–78.

75. Messner SF, Tardiff K. Economic inequality and levels of homicide: an analysis of urban neighborhoods. Criminology. 1986;24:297–317.

76. Kposowa AJ, Breault KD, Harrison BM. Reassessing the structural covariates of violent and property crimes in the USA: a county-level analysis. Br J Sociol. 1995;46(1):79–105.

77. Gutierrez Rufrancos H, Power M, Pickett KE, Wilkinson R. Income inequality and crime: a review and explanation of the time-series evidence. Sociol Criminol Open Access. 2013;1(1):e103.

78. Peterson RD, Krivo LJ. Racial segregation, the concentration of disadvantage, and black and white homicide victimization. Sociol Forum. 1999;14(3):465–93.

79. Lee MR, Ousey GC. Counterbalancing disadvantage? Residential integration and urban black homicide. Soc Prob. 2007;54(2):240–62.

80. Krivo LJ, Peterson RD, Kuhl DC. Segregation, racial structure, and neighborhood violent crime. Am J Sociol. 2009;114(6):1765–802. doi: 10.1086/597285 19852253

81. Anopov A, Rothman EF, Cronin SW, Franklin L, Cansever A, Potter F, et al. The role of racial residential segregation in black-white disparities in firearm homicide at the state level in the United States, 1991–2015. J Natl Med Assoc. 2019;111(1):62–75. doi: 10.1016/j.jnma.2018.06.002 30129481

82. Burton CE. Segregation and Latino homicide victimization. Am J Crim Justice. 2004;29(1):21–36.

83. Phillips JA. White, black, and Latino homicide rates: why the difference? Soc Prob. 2002;49(3):349–73.

84. Xie M. The effects of multiple dimensions of residential segregation on black and Hispanic homicide victimization. J Quant Criminol. 2010;26(2):237–68.

85. Tuttle J. Specifying the effect of social welfare expenditures on homicide and suicide: across-national, longitudinal examination of the stream analogy of lethal violence. Justice Q. 2018;35(1):87–113.

86. Wilson M, Daly M. Life expectancy, economic inequality, homicide, and reproductive timing in Chicago neighborhoods. BMJ. 1997;314(7089):1271. doi: 10.1136/bmj.314.7089.1271 9154035

87. LaFree G. Losing legitimacy: street crime and the decline of social institutions in America. London: Routledge; 2018.

88. Mabry PL, Marcus SE, Clark PI, Leischow SJ, Méndez D. Systems science: a revolution in public health policy research. Am J Public Health. 2010;100(7):1161–3. doi: 10.2105/AJPH.2010.198176 20530757

89. The Washington Post. 994 people shot dead by police in 2015. The Washington Post; 2019 [cited 2019 Jun 1]. https://www.washingtonpost.com/graphics/national/police-shootings/.

90. Feld S, Bauldry S. Separate, unequal, and uncorrelated: why we need to consider race-specific homicide rates in U.S. metropolitan areas. Socius. 2018;4:1–8. doi: 10.1177/2378023118773959

91. Greenberg D. The end of neutrality. Politico Magazine. 2018 Sep 6 [cited 2019 Jun 1]. https://www.politico.com/magazine/story/2018/09/06/common-ground-good-america-society-219616.

92. Kim D. Projected impacts of federal tax policy proposals on mortality burden in the United States: a microsimulation analysis. Prev Med. 2018;111:272–9. doi: 10.1016/j.ypmed.2017.10.021 29066374

93. Greenstone M, Looney A, Patashnik J, Yu M. Thirteen economic facts about social mobility and the role of education. Washington (DC): Hamilton Project; 2013.

94. Blanden J, Gregg P, Machin S. Intergenerational mobility in Europe and North America. A report supported by the Sutton Trust. London: Centre for Economic Performance; 2005 Apr [cited 2019 Jun 1]. https://www.suttontrust.com/wp-content/uploads/2005/04/IntergenerationalMobility.pdf.

95. Boston Consulting Group, Sutton Trust. The state of social mobility in the UK. London: Sutton Trust; 2017 Jul [cited 2019 Jun 1]. https://www.suttontrust.com/wp-content/uploads/2017/07/BCGSocial-Mobility-report-full-version_WEB_FINAL.pdf.

96. Pike H. Life expectancy in England and Wales has fallen by six months. BMJ. 2019;364:l1123. doi: 10.1136/bmj.l1123 30858167

97. Shaw D. Ten charts on the rise of knife crime in England and Wales. BBC News. 2019 July 18 [cited 2019 Jun 1]. https://www.bbc.com/news/uk-42749089.