Transcript Gun Violence in Indiana Issues and Answers

Stephen Dunlop, MD
President
Hoosiers Concerned About Gun Violence
3535 Kessler Blvd. , North Drive
Indianapolis, IN 46222
[email protected]
Suicide Prevention, April 3, 2008
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Does access to guns influence:
◦ Risk of suicide in a community?
◦ Risk of suicide in a home?
◦ Risk of suicide among some individuals more than
others?
◦ What does this mean for Indiana?
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15 States
116 million people
47% Gun Ownership
Firearm Suicides
9749
Non Firearm suicides
5060
Total suicides
14,809
Firearm suicides per
100,000
8.4
High Gun Ownership
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6 States
119 million people
15% gun ownership
Firearm Suicides 2606
Non-firearm Suicides
5446
Total Suicides
8052
Firearm suicides per
100,000
2.2
Low gun Ownership
Miller, M, et al, Household Firearm Ownership and Rates of Suicide… , J of Trauma,
62(4), 1029-1035, 2007
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Case Control studies are often used to
determine whether a gun in the home
increases the risk of suicide
These studies find a risk of 2.1 to 4.8 times
greater for suicide when a gun is present
Shah and colleagues looked at adolescent
suicides in Colorado from 1991 to 1993
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36 of 54 suicides were committed with a gun
24 used a gun form home, 2 a non resident
parent’s gun, 2 a relative’s, 4 a friend,
neighbor or acquaintance, 4 unknown
42% used a handgun
Only 25% of the guns were stored locked
Shah, et al , Adolescent suicide and household access to
firearms…, J of Adolescent Health, 26 (3), 2000,157-163
Variable
Cases
Controls
P value
A gun in the
home
72%
50%
.05
An unlocked
gun
58%
35%
.05
> 1 gun
56%
28%
.02
Conduct
problem
64%
25%
<.01
Mental Health
Rx
47%
19%
.01
Ever drank
alcohol
54%
34%
<.01
Shah, et al , Adolescent suicide and household access to
firearms…, J of Adolescent Health, 26 (3), 2000,157-163
Variable
Adjusted Odds Ratio
Conduct Disorder Related
Behaviors
7.45
Past Mental Health Problem
4.84
Household access to a gun
3.91
Ever drank Alcohol
1.86
Shah, et al , Adolescent suicide and household access to
firearms…, J of Adolescent Health, 26 (3), 2000,157-163
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Dahlberg and colleagues decided to look at a
random national sample to get broader
picture of the risks of guns in the home
They used data from the 1993 Mortality
Followback Survey which collected data on a
10% sample of all deaths of persons 15 years
or older
They focused on deaths by homicide, suicide,
or accident that occurred in the home
Type of
Death
#
%
Age Firearm
Male <45 used
Firearm in
the Home
Corrected Odds Ratio
Suicide vs. Other
Homicide vs. Other
For gun in the home
Suicide
1049 81%
50%
68%
72%
Males 10.4**
Females 2.3
Homicide
490
63%
73%
68%
42%
1.9*
Other
535
37%
22%
0%
32%
** p<.01
* p<.02
Dahlberg, LL, Ikeda, RM, Kresnow, M, Guns in the Home
and Risk of a violent Death, Am J Epidemiology, 160
(10), 929-936)
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Grossman et al studied 106 suicide and gun
injury cases from Washington, Oregon and
Missouri in individuals less than 20 years old
82 Suicide attempts, 95% fatal
24 unintentional injuries, 50% fatal
Control gun owning households were found
by random telephone dialing and matched by
age group of a household member and
county
Storage Practice
/Safety Device
Cases
N=106
Controls
N=480
Gun loaded
34%
9%
Gun unloaded
66%
91%
Gun and Ammo stored
separately
41%
65%
Both accessible
56%
28%
Gun locked
32%
58%
Ammunition locked
24%
48%
Both locked
17%
35%
Grossman et al, Gun Storage Practices…, JAMA,293,707-714,
2005
Storage Practice
Odds Ratio
Gun and Ammunition Accessible
1.0
Gun Accessible, Ammunition Not
0.47
Ammunition Accessible, Gun Not
0.34
Neither Accessible
0.22
Grossman et al, Gun Storage Practices…, JAMA,293,707-714,
2005
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All 1397 suicides in Finland in one year were
studied
21% were by shooting
This method was associated with male sex,
living with a partner, lack of previous
psychiatric treatment or suicide attempts
About 25% of Finnish households own fire
arms
Pirkola S, et al, Do Means matter? Differences in
Characteristics of Finnish Suicides…
J Nervous and Mental Disorders, 2003;191:745-750
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In Switzerland, men must keep a weapon at
home during compulsory military service
Suicides in Basel from 1992-1996 were
examined
Firearms accounted for 30%, 11% were with
military weapons
Military firearm suicides were younger, more
likely to have white collar jobs, less likely to
have a psychiatric diagnosis, a prior attempt,
or be single than those using other methods
Frei,A, et al, Use of Armay Weapons and Firearms
for Suicide and Homicide, Crisis, 27(3), 140-145,
2006
Age-Adjusted Rate per 100,000
Figure 8: Indiana Suicide Rates by Race and Age,
2001-2005
35
30
25
20
15
10
5
0
10-14
15-19
20-24
25-34
35-44
45-54
55-64
65+
White Males
1.57
14.11
21.3
25.66
27.79
29.14
22.39
31.48
Black Males
1.56
4.41
27.89
24.07
17.62
13.16
12.83
7.97
White Females
0.73
3.07
3.2
5.57
7.97
7.63
6.23
2.85
Age
Indiana State Department of Health, Suicide Report,
2001-2005)
Figure 7: Indiana Suicide Deaths by Gender and Age, 2001-2005
700
600
400
White Males
300
Black Males
White Females
200
Black Females
100
+
85
-8
4
75
-7
4
65
-6
4
55
-5
4
45
-4
4
35
-3
4
25
-2
4
20
-1
9
15
-1
4
0
10
Deaths
500
Ages
Indiana State Department of Health, Suicide Report, 2001-2005)
Table 4: Indiana Suicide Rates by Mechanism, Race and Gender, 20012005
Mechanism White
Males
Number
Death Rate*
Firearms
1688
12.71
Suffocation 607
4.49
Poisoning 338
2.49
All
2633
RATE
19.7
Black Males
Number
Death Rate*
99
8.14
35
2.70
Too few for
rate
134
10.8
White
Females
Number
Death Rate*
234
1.66
90
0.65
261
1.87
585
4.18
All
Number
(%)
2021
(60%)
732
(22%)
599
(18%)
3595
11.7
*Rates are per 100,000 population and are age-adjusted
Indiana State Department of Health, Suicide Report, 2001-2005)
 In
Indiana
 44.2% of families reported owning
a gun*
 25.8% reported owning a
handgun*
 9.6% store guns loaded**
 6% store guns loaded and
unlocked**
*Indiana Firearm Survey, 2004**Miller, M, Firearm Storage,
Accident Analysis and Prevention (2005), 37, 661-667
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This is a problem usually involving legal guns
accessed by people at risk from personality
disorders, mental illness, substance abuse,
physical illness, old age, etc.
Simply removing guns from the community
on a large scale is the simplest and would
probably be the most effective measure.
Regulation of gun storage could limit the risk.
Enforced waiting periods under Brady led to a
decrease in suicide.
Educational campaigns may be helpful.
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Background checks at gun shows 87%
Wiating period to buy a handgun 85%
Raise age to 21 for purchase of a long gun
63%
Storage requirements for guns 73%
Child Access Prevention Law 73%
Safety Training for New Owners 83%
Recognition device for new handguns 75%
Year
Gun in the Household
Handgun in the
Household
2000
48.6%
29.5%
2004
44.2%
25.8%
Indiana Partnership to Prevent Gun Violence, July,2004
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Suicide Rates for Youths and Young Adult Males
10-14
Year
Olds
20-24
Year
Olds
15-19
Year
Olds
Year
Firearm
Other All
Firearm
Other All
Firearm
Other All
1994
1.4
0.9
2.4
13.1
4.8
18.0
18.8
9.2
28.0
1999
0.8
0.8
1.9
8.4
4.7
13.0
12.8
8.0
20.9
2004
0.5
1.3
1.7
6.5
6.2
12.7
11.1
9.7
20.8
Change
94-04
-0.9
+.4
-0.7
-6.6
+1.4
-5.3
-7.7
+0.5
-7.2
MMWR 9/7/ 2007, CDC, DHHS, rates per 100,000 in the age and gender group
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If Indiana were to somehow become a low
gun ownership state, we might expect little
change in non gun suicides but gun suicides
to go from 60% to 33% of all suicides
For an average year this would decrease the
number of suicides from about 700 to about
420. The decrease would come preferentially
from suicides in younger males.