Neighborhood Deprivation, State Laws, and Firearm Injury in the US

Firearm injury remains a pressing public health crisis in the US, yet the relative influence of neighborhood deprivation and state firearm laws is not well understood.

To assess the associations of neighborhood deprivation, state firearm law strength, and urbanicity with firearm injury rates across the US.

This was a population-based cross-sectional study conducted at the Census block group level across the entire US from January 2018 through December 2022. Gun Violence Archive data were used to identify and include fatal and nonfatal firearm injuries in individuals of all ages. Suicide-related firearm injuries were excluded. Data were analyzed from March to June 2025.

Neighborhood deprivation measured by the 2020 Area Deprivation Index at the census block group level, state firearm law strength determined by the 2020 Giffords Law Center Annual Gun Law Scorecard, and urbanicity (urban, mixed, and rural categories) based on 2020 Census Bureau urban-rural classifications. A spatial lag variable for neighboring state firearm law strength was also included.

Firearm injury rates per 1000 population in a Census block group was evaluated using negative binomial regression to estimate incident rate ratios (IRR). Spatial autocorrelation was assessed using bivariate Moran I statistics.

Across 233 386 Census block groups, 206 082 shooting incidents were analyzed (81 241 fatalities and 176 179 nonfatal injuries). On multivariable analysis, each decile increase in Area Deprivation Index (ADI) was associated with a 25% increase in firearm injury rates (IRR, 1.25; 95% CI, 1.25-1.26; P < .001) while incremental strengthening of state firearm law grade was associated with a 5% decrease (IRR, 0.95; 95% CI, 0.95-0.96; P < .001). Neighboring state law strength had a weaker association (IRR, 0.99; 95% CI, 0.99-1.00; P < .001). Compared to urban block groups, mixed (IRR, 0.39; 95% CI, 0.37-0.41) and rural (IRR, 0.22; 95% CI, 0.22-0.23) block groups had significantly lower rates (P < .001 for both). Bivariate global Moran I confirmed positive spatial autocorrelation between ADI and shooting incidents (I, 0.76; P < .001).

In this national cross-sectional study, neighborhood deprivation demonstrated a substantially stronger statistical association with firearm injury rates than did state firearm law strength. While firearm legislation is crucial, strategies that prioritize investment in socially and economically deprived communities, especially in urban settings, may yield more meaningful reductions in firearm injuries overall.