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Urban-rural shifts in intentional firearm death: different causes, same results
Charles C Branas1, Michael L Nance, Michael R Elliott
1Department of Biostatistics and Epidemiology, University of Pennsylvania, 829 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA. cbranas@cceb.med.upenn.edu
Objectives:
We analyzed urban-rural differences in intentional firearm death.
Methods:
We analyzed 584629 deaths from 1989 to 1999 assigned to 3141 US counties, using negative binomial regressions and an 11-category urban-rural variable.
Results:
The most urban counties had 1.03 (95% confidence interval [CI]=0.87, 1.20) times the adjusted firearm death rate of the most rural counties. The most rural counties experienced 1.54 (95% CI=1.29, 1.83) times the adjusted firearm suicide rate of the most urban. The most urban counties experienced 1.90 (95% CI=1.50, 2.40) times the adjusted firearm homicide rate of the most rural. Similar opposing trends were not found for nonfirearm suicide or homicide.
Conclusions:
Firearm suicide in rural counties is as important a public health problem as firearm homicide in urban counties. Policymakers should become aware that intentional firearm deaths affect all types of communities in the United States.
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