Number of deaths due to firearms per 100,000 population.
The 2019 County Health Rankings used data from 2013-2017 for this measure.
Reason for Including
Gun violence is a leading contributor to premature death in the United States. 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%). In the United States, the firearm-related suicide and homicide rates are 8.0 and 25.2 times higher, respectively, than other high-income countries. 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]
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 (i.e., deaths, births, etc.) 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 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.
Years of Data Used
CDC WONDER mortality data
The Compressed Mortality File (CMF) is a county-level national mortality and population database spanning the years 1968-2017. Compressed Mortality data are updated annually. The number of deaths, crude death rates and age-adjusted death rates can be obtained by place of residence (total U.S., Census region, Census division, state, and county), age group, race (years 1968-1998: White, Black, and Other; years 1999-present: American Indian or Alaska Native, Asian or Pacific Islander, Black or African American, and White), Hispanic origin (years 1968-1998: not available; years 1999-present: Hispanic or Latino, not Hispanic or Latino, Not Stated), gender, year of death, underlying cause of death (years 1968-1978: 4 digit ICD-8 codes and 69 cause-of-death recode; years 1979-1998: 4-digit ICD-9 codes and 72 cause-of-death recode; years 1999-present: 4-digit ICD-10 codes and 113 cause-of-death recode), and urbanization level of residence (years 1968-1998: not available; years 1999-present: per the 2006 or the 2013 NCHS Urban-Rural Classification Scheme for Counties).
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.
 Bangalore, S., & Messerli, F.H. (2013). Gun ownership and firearm-related deaths. American Journal of Preventive Medicine, 126(10), 873-6.
 Xu, J., Murphy, S.L., Kochanek, K.D., & Bastian, B.A. (2016). Deaths: Final data for 2013. National Vital Statistics Reports, 64(2).
 Grinshteyn, E., & Hemenway, D. (2016). Violent death rates: The US compared with other high-income OECD counties, 2010. The American Journal of Medicine, 129(3), 266-73.
 Miller, M., Azreal, D., & Baerber, C. (2012). The important of attending to method in understanding population-level disparities in the burden of suicide. Annual Review of Public Health, 33, 393-408.
 Monuteaux, M.C., Lee L.K., Hemenway, D., Mannix, R., & Fleegler, E.W. (2015). Firearm ownership and violent crime in the U.S.: An ecologic study. American Journal of Preventive Medicine, 49(2), 207-14.