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When Lockdowns Were Not Equal: State COVID-19 Policies and Firearm Mortality Across Demographic Groups
William M Rice1,2, Asad H Khan1, Jack Otterson1
1Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
The American Surgeon
|July 28, 2026
Summary
State lockdown policies during COVID-19 had varied effects on firearm mortality rates. While some groups saw increases in homicide, others experienced decreases in suicide, highlighting the need for targeted interventions.
Area of Science:
- Public Health
- Epidemiology
- Sociology
Background:
- Firearm mortality rose in the U.S. during the COVID-19 pandemic.
- The association between state lockdown stringency and firearm mortality changes across demographics remained unclear.
Purpose of the Study:
- To investigate the relationship between COVID-19 lockdown stringency and firearm mortality rates.
- To determine if these associations varied by demographic group and intent (homicide, suicide).
Main Methods:
- Ecological cross-sectional study using CDC WONDER mortality data (2018-2021).
- Oxford COVID-19 Government Response Tracker Stringency Index measured lockdown stringency.
- Firearm mortality rate ratios compared 2020-2021 to 2018-2019, stratified by demographics and intent.
Main Results:
- Of 173,499 firearm deaths, 57.1% were suicides and 39.6% homicides.
- Only 12.3% of demographic cohorts showed significant associations with policy stringency.
- Stricter policies correlated with higher homicide rates in specific Black demographic groups and young adult males; varied associations were found for suicide.
Conclusions:
- Stricter COVID-19 lockdown policies showed mixed associations with firearm mortality across different demographic groups.
- Most cohorts did not exhibit significant links between policy stringency and firearm mortality changes.
- Findings emphasize the need for tailored mental health and violence prevention strategies considering policy impacts on diverse populations.
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