Number of deaths due to firearms per 100,000 population. The 2023 County Health Rankings used data from 2016-2020 for this measure.
Gun violence is a leading contributor to premature death in the United States.1 Firearm fatalities are a critical public health issue as they are largely preventable. The vast majority of firearm fatalities are the result of suicides (63%) and homicides (33%).2 In the United States, firearm-related suicide and homicide rates are 8.0 and 25.2 times higher, respectively, than other high-income countries.3 Studies have shown that suicidal acts that prove fatal are strongly associated with the availability of household guns, and state-level rates of gun ownership are significantly associated with firearm and overall homicide rates.4,5
Data and methods
National Center for Health Statistics - Mortality Files
Data on deaths and births were provided by NCHS and drawn from the National Vital Statistics System (NVSS). These data are submitted to the NVSS by the vital registration systems operated in the jurisdictions legally responsible for registering vital events (i.e., births, deaths, marriages, divorces, and fetal deaths). In prior years of the Rankings, Premature Death was calculated by the National Center for Health Statistics, but this year the Mortality-All County (micro-data) file was requested. This allowed us to calculate Premature Death and Life Expectancy ourselves. While most calculations of mortality rates can be downloaded from CDC WONDER, the calculation of Years of Potential Life Lost and Life Expectancy requires raw data files.
Key Measure Methods
Firearm Fatalities is a rate
Firearm Fatalities is the number of deaths due to firearms in a county per 100,000 population. Rates measure the number of events (e.g., deaths, births) in a given time period (generally one or more years) divided by the average number of people at risk during that period. Rates help us compare health data across counties with different population sizes.
Deaths are counted in the county of residence for the person who died, rather than the county where the death occurred
It is important to note that deaths are counted in the county of residence of the deceased. So, even if a firearm death occurred across the state, the death is counted in the home county of the individual who died.
Some data are suppressed
A missing value is reported for counties with fewer than 10 firearm fatalities in the time frame.
The numerator is the number of deaths in a county over the 5-year period due to firearms as defined by ICD-10 codes W32-W34, X72-X74, X93-X95, Y22-Y24, and Y35.0.
The denominator is the aggregate annual population over the 5-year period.
Can This Measure Be Used to Track Progress
This measure can be used to track progress with some caveats. It is important to note that the estimate provided in the County Health Rankings is a 5-year average. However, in most counties, it is relatively simple to obtain single-year estimates from the resource included below.
Firearm fatality data can also be further broken down by year and intent, which could help measure the impact of interventions specific to firearm fatality prevention.
Finding More Data
Disaggregation means breaking data down into smaller, meaningful subgroups. Disaggregated data are often broken down by characteristics of people or where they live. Disaggregated data can reveal inequalities that are otherwise hidden. These data can be disaggregated by:
Using CDC WONDER, mortality data can be grouped by age group, race, gender, and place of residence, including subcounty geographies. Rates can be exported as raw or age-adjusted. Small counties might need to combine multiple years of data to see rates, as CDC suppresses any rates when there are fewer than 10 deaths.
1 Bangalore S, Messerli FH. Gun ownership and firearm-related deaths. The American Journal of Medicine. 2013; 126(10):873-6.
2 Xu J, Murphy, SL, Kochanek KD, Bastian BA. Deaths: Final data for 2013. National Vital Statistics Reports. 2016; 64(2).
3 Grinshteyn E, Hemenway D. Violent death rates: The US compared with other high-income OECD counties, 2010. The American Journal of Medicine, 2016; 129(3):266-73.
4 Miller M, Azrael D, Barber C. Suicide mortality in the United States: The importance of attending to method in understanding population-level disparities in the burden of suicide. Annual Review of Public Health. 2012; 33:393-408.
5 Monuteaux MC, Lee LK, Hemenway D, Mannix R, Fleegler EW. Firearm ownership and violent crime in the U.S.: An ecologic study. American Journal of Preventive Medicine. 2015; 49(2):207-14.